Ethics Committee Amendment Request Form
Project Details
Project Title
Reference Number / ID
Principal Investigator
Department / Unit
Amendment Request
Type of Amendment (Select all that apply)
Study design/protocol
Study population
Informed consent material
Data collection / questionnaires
Personnel
Other
Please describe in detail the proposed amendment
Rationale for Amendment
Impact Assessment
Will this amendment affect participant safety, privacy or confidentiality?
Yes
No
If yes, please provide details
Supporting Documents
List all revised/additional documents submitted with this amendment request
Declaration
Name of person submitting form
Date