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					Justice Research Ethics
Amendment Request Form



DOJ Application Number
 CF /

Date of Request



Full Project Title



Principal Researcher



  Important
  To complete this form:
        Fill in check boxes for yes/no answers by double-clicking on the check box and
          selecting the “checked” option under the Default Value.
        Fill in text frames by typing your answers (or copying and pasting from another
          document) in the space provide. The frame will expand to accommodate the text.



         Project Summary
Please provide a brief summary of the approved project, including a brief statement of the main
objective of the project and the methodologies (up to 150 words)




         Project Amendments

1. Does the amendment involve a change of personnel on the research team?
                               Yes               No

If Yes, provide details in the following box . Copy and paste Question 7 of the Application Form to a
new page and complete the relevant section for each new researcher. If the principal researcher is
changing, the new principal researcher must sign the Principal Researcher Declaration.


Department of Justice Ethics Amendment Request Feb 2008                                    Page 1 of 3
  Researchers leaving the project:

  Researchers joining the project:

  Qualifications and a brief summary of relevant experience for this project must be provided for new
  members joining the research team.




2. Does the amendment involve an extension to the approval or a re-activation of the
   approval?
                               Yes               No

If Yes, provide details in the box below

  Original expected completion date:

  New expected completion date:

  Reason for the extension or re-activation:



3. Does the amendment involve changes to Participant Information, Consent Forms or
   letters of invitation?
                               Yes               No

If Yes, provide modified versions of the relevant documents and, if feasible, an original version with
“tracked changes” showing.



4. Does the amendment involve changes to other documents, such as surveys or
   questionnaires?
                               Yes               No

If Yes, provide modified versions of the relevant documents and, if feasible, an original version with
“tracked changes” showing.



5. Does the amendment have privacy implications?
                               Yes               No
If Yes, complete Section 4 of the Application Form for the new information that is to be collected,
used or disclosed.




Department of Justice Ethics Amendment Request Feb 2008                                     Page 2 of 3
6. Summarise the amendment(s) to the approved project, including justification for the
   changes and any ethical issues that the amendment raises. This question must be
   completed.




        Principal Researcher Declaration


I confirm that this project was conducted as originally approved by the Department of Justice HREC
(and subject to any changes subsequently approved) and that all adverse events were reported to the
Committee according to the Committee’s guidelines for reporting of adverse events and the NHMRC
National Statement on Ethical Conduct in Human Research (2007).



Principal Researcher Signature: ___________________________________________


Date: __________________________________




Department of Justice Ethics Amendment Request Feb 2008                                 Page 3 of 3

				
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