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Trinity  College  Institutional  Review  Board  (IRB)    

Renewal  and/or  Modification  Request  PDF  


 
Only  use  this  form  to  request  a  renewal  and/or  modification  of  research  that  has  been  
previously  approved  by  the  Trinity  IRB,  no  later  than  one  year  from  original  approval  date  
 
-­  See  instructions  http://www.trincoll.edu/Academics/dean/research/review/Pages/default.aspx  
-­  Review  with  your  Trinity  faculty  sponsor,  if  appropriate,  and  complete  online  ethics  training  
-­  Fill  out  this  digital  PDF  form  with  Preview  (on  Mac)  or  Adobe  Acrobat  Reader  (Windows/Mac)  
-­  Save  this  PDF  and  email  with  any  attachments  to  Trinity  IRB  administrator  at  irb@trincoll.edu  
-­  Trinity  IRB  review  may  require  up  to  2  weeks,  or  longer  for  higher-­risk  or  complex  projects  
-­  You  may  not  collect  individually  identifiable  research  data  prior  to  receiving  IRB  approval  
 
A)  Applicant  (Principal  Investigator)  
Current  IRB  ID  (from  approval  letter)    

New  IRB  ID  (leave  blank  for  admin)    

Name    

Email    

Student/Staff/Faculty/Guest    

Dept/Program/Course    

Project  Title    
 
 

Date  submitted  (for  this  request)    

Estimated  end  date    


 
B)  Type  of  request  
   
  Renewal  of  an  existing  IRB  approval,  within  the  past  year,  for  up  to  one  more  year  
 
Modification  of  an  existing  IRB  approval,  within  the  past  year  
 
 
 
 
 
 
 

Trinity  IRB  Renew-­Modify  PDF  2016-­08             page  1  


C)  Details  
-­  If  requesting  a  renewal  with  no  changes,  list  the  new  estimated  end  date  on  the  previous  page  
and  state  that  there  are  no  changes  in  the  box  below.  
-­  If  requesting  a  modification,  describe  any  changes  to  your  approved  IRB  application.    
-­  Feel  free  to  attach  your  previous  application  and  refer  to  changes  in  specific  sections  (e.g.  D4).  
 
You  may  type  or  copy  and  paste  into  the  automatically  scrolling  text  field  below.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
D)  Assurance  
By  submitting  this  form,  I  certify  that  the  procedures  described  above  are  accurate  and  will  be  
followed  in  the  course  of  the  research  project.  Also,  if  my  project  is  approved,  I  agree  to  notify  
the  IRB  immediately  of  any  changes  to  procedures  and  if  unanticipated  problems  arise  during  
the  research  process.       To  certify  this  statement,  type  your  name  below:  
 
 
 
 
 

Trinity  IRB  Renew-­Modify  PDF  2016-­08             page  2  


Reviewer  criteria  and  comments  (to  be  completed  only  by  Trinity  IRB  members)  
Does  this  application  for  human  participants  research  meet  our  ethical  standards?  
a)  Are  risks  minimized?  
b)  Reasonable  risks  for  anticipated  benefits?    
c)  Equitable  selection  of  participants?  
d)  Appropriate  informed  consent?  
e)  Confidentiality  of  data  plan?  
f)  Additional  safeguards  for  vulnerable  populations?  
Recommendation:  
  Approve  
  Needs  revisions  (explain  in  comments)  
  Needs  further  review  by  IRB  chair  or  full  committee  (explain  in  comments)  
Comments  (will  be  shared  with  the  applicant;;  auto-­scrolling  text  box)  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Trinity  IRB  Renew-­Modify  PDF  2016-­08             page  3