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									                                         Tulane University
                             Institutional Biosafety Committee (IBC)
                          Request for Amendment to Approved Protocol

Principal Investigators (PIs) must submit this form to request changes or modification to a previously
approved IBC protocol. It is the responsibility of the PI to notify the IBC of changes to an approved
protocol. The original protocol approval will expire at the previously approved expiration date (original 3 or
2 year approval). It is recommended that the IBC Chair be consulted in advance of filling out this form as
some changes may require submittal of a new protocol or additional information. Send this form by e-mail
to ibc@tulane.edu

Approved IBC protocol Number:                                        Date of approval:
Protocol title:

Principal Investigator:                         Department :                             School:

Telephone :                                     E-mail

Check the items that differ from your last application:
Project title
Location of Project :
Biosafety level
New personnel:
Use of Recombinant DNA
Type of Infectious agents
Use of other biological reagents (blood, body fluids, cell lines):
Use of transgenic plants or animals
Use of Select Agents or toxins

Provide details of the intended changes. The IBC will determine if your proposed changes can be done
via an amendment or require submission of a new protocol (add additional pages if necessary)

Signature of PI:____________________________        Date:
                                          Page 1 of 2
                                                                     IBC Amendment Form- January 2010
For IBC use only:

Protocol number:                                   Amendment number:

This amendment is: APPROVED :              NOT APPROVED :

Signature of IBC: _________________________ __          Date:

                                          Page 2 of 2
                                                            IBC Amendment Form- January 2010

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