Kentucky State University Office of Research and Innovation 400 E Main St, Frankfort KY, 40601 ORI@KYSU.EDU (502) 597-5997
Modification Request Form
Describe Each Modification
REQUIRED: For each proposed modification, describe the currently approved procedures, forms, etc., then summarize the proposed change, addition, etc. Include a justification for the modification request. Add additional sheets if necessary.
Example
Currently Approved: study staff as listed on attached SP List Template.
Proposed Revision: add Jane Doe, MD, as co-investigator. Dr. Doe has completed human-subject-protections training, is a new faculty member who will work with subjects on this protocol, and is authorized to obtain consent.
1 Currently Approved
Proposed Revision
Currently approved 1
Proposed revision 1
2 Currently Approved
Proposed Revision
Currently approved 2
Proposed revision 2
3 Currently Approved
Proposed Revision
Currently approved 3
Proposed revision 3