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					                                  Request for Modification
                           1B AUTHORIZATION TO RELEASE FUNDS


Please fill out this form if you have previously requested and obtained authorization for the release of
funds which are to be used to conduct preliminary research activities that do not involve human
participants, and would like to extend the authorization or request the release of additional funds.

Please answer all of the following questions.

Name of Principal Investigator (or Supervisor): (Note: If this is a 4th year, Master’s or Doctorate
project, indicate your supervisor’s name)
Address (Include building name and room           Department/School:
number):                                          Faculty:
                                                  E-mail:
                                                  Phone:                   Fax:

Co-investigators and students (4th year, Master’s or Doctoral levels)
Name:                                            Department/School:
Address:                                         Faculty:

                                                      E-mail:
                                                      Phone:                      Fax:
Name:                                                 Department/School:
Address:                                              Faculty:

                                               E-mail:
                                               Phone:                             Fax:
Have any team members left or been added to the research team?
  Yes        No

If yes, please provide their names, their role in the project and their contact information (if a
new member of the research team).



Preferred language of correspondence:              French                English

Ethics File number:
Title of the research project:

Initial date of approval:
Date of prior renewal(s) (if applicable):
Name of funding agency:                                                         U of O RE # :
NB: If you received a Category 1B approval and you are now ready to proceed with the phase of
the project in which you will have contact with human subjects, you must submit a complete
application for 1A approval to the REB.
1. What is the current status of your project?

2. Do you need an extension of your 1B authorization?

  Yes         No

If yes  1) please explain why:
        2) until what date do you want the authorization extended:
3. Do you need additional funds to be released?
   Yes        No

If yes, how many additional funds are you requesting?

How will the funds be used?

4. When do you anticipate proceeding to the phase involving interaction with human
participants?




SIGNATURE:                                                                      DATE:

NAME:

SIGNATURE:                                                                      DATE:

NAME:

SIGNATURE:                                                                      DATE:

NAME:



Print and mail to:

Office of Research Ethics and Integrity
550 Cumberland (Tabaret Hall), Room 154
University of Ottawa
Ottawa, Ontario K1N 6N5, Canada
Email: ethics@uottawa.ca
Phone: (613) 562-5387
Fax: (613) 562-5338

Notice of Collection of Personal Information : Your personal information is collected under the authority of the
University of Ottawa Act and is indented to be used for the purpose of and those consistent with the administration
and the evaluation of the eligibility of your project for ethics approval. If you have any questions regarding this
collection of personal information, please contact us by telephone at (613) 562-5387 or by email at
ethics@uOttawa.ca.

				
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