The Institutional Review Board (IRB) on The

The Institutional Review Board (IRB) on The

Extension Request Form

The Institutional Review Board (IRB) on the

Use of Human Subjects in Research

James Madison University

Projects can only be approved for one year at a time and can be renewed up to three years from the original project begin date. After the third year it will need to be resubmitted as a new protocol for review and approval. Please submit within 30 days before the project end date to ensure there is no lapse in IRB approval.

IRB Protocol #:

Project Title:

Name of Researcher(s):

Faculty Advisor (if applicable):

Indicate the year of the study being requested to begin:

Second Year: Third Year:

Current Project End Date:

Requested New Project End Date (cannot exceed one year minus one day):

  1. What is the current status of your study?

Project is active and subjects continue to be enrolled

Project is closed to subject enrollment, but subjects are still participating in the research

Subject participation is complete, but project is still open for follow-up of subjects

Subject participation is complete, but project is still open for data analysis of identifiable data.

  1. To date, how many subjects have been enrolled in the study?
  1. How many participants were indicated in the original intended sample size?
  1. Provide an abstract of findings or summary of progress to date:
  1. Please provide a justification for the request to extend the study:
  1. State any changes being made to the originally approved protocol and provide justification for the requested changes:
  1. Attach amended material, as applicable (highlight all changes):

Certification:

I certify that the information supplied on this form and in accompanying attachments is complete and accurate and that no procedures other than those disclosed on this form will be used in this protocol. I will promptly report to the IRB all research-related accidents, injuries, complaints, problems, or breeches of confidentiality. I will report any significant new findings that may affect the risks and benefits to the subjects and other participants in writing to the research participants and to the IRB.

Signature: Date:

Signature: Date:

Signature: Date:

Signature: Date:

Faculty Advisor Signature: Date:

Submit electronic copy to and a “signed” hard copy to the

Office of Research Integrity, MSC 5738 | 801 Carrier Drive |Engineering/Geosciences (EnGeo) Building, Room # 3152

(Electronic signatures are accepted. If including electronic signature(s), a hard copy is not needed.)

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