Eastern University IRB Protocol Extension Request Form
This form is to be completed by the Principal Investigator.  An Extension Request must be submitted and approved prior to the one year deadline for the original IRB Approval date.  Prior to submitting this form, please inform the IRB via email (irb@eastern.edu) of your intent to submit a Protocol Extension Request form.  Please complete this google form completely.  After submitting this google form, you will receive a pdf of the completed form via email (this may take a few minutes). You must then sign it, obtain your advisor's signature, and submit the form to the IRB Brightspace page under the "Extension Request for Previously Approved IRB Application" folder.  
Email *
Extension Request Date *
MM
/
DD
/
YYYY
Extension requested through (please provide date, must be within one-year from date this request is being made) *
MM
/
DD
/
YYYY
IRB Approval Date (approval of original application) *
MM
/
DD
/
YYYY
If an Amendment and/or an Extension were previously obtained for this project, please list all approval dates here (write N/A if not applicable) *
Principal Investigator(s) *
PI email address *
Advisor's Name (or Dean's Name, if faculty researcher) *
Advisor's email address (or Dean) *
Title of previously approved IRB Protocol *
Has this project been completed (i.e. have you finished gathering data and have all individual identifiers been removed from the data; or have you archived individually identifiable data that you plan to use for future studies?) *
Will the research protocol or consent form be modified in any way? *
If any modifications or changes are being made, please describe them below AND submit an Amendment Request Form
Have any subjects complained about the research or reported any injury? *
Note: Extension requests must be submitted and approved prior to the one year deadline for the original IRB Approval.  Research conducted outside of the one year timeline is out of compliance. 

After clicking submit, a pdf of your submission will be emailed to you (this may take several minutes).  After you receive the pdf, you and your advisor (or dean) will need to sign the form, and then submit it to the IRB Brightspace folder.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Eastern University.

Does this form look suspicious? Report