Please provide a statement on the following relating to the current progress of the study. Recruitment to Date: (i.e. On / not on target etc. ) Budget: (i.e. on budget, above, below etc.) Safety and adverse events: (i.e. within expected ranges, higher than expected etc.) Does the amendment involve the addition of any procedures involving ionising radiation? If yes, please consult the Radiation Safety Officer prior to submitting your application and provide their report with your application. Please list all documents being submitted with version control information: i.e. TITLE, Version xx, Date DECLARATION: By submitting this application for amendment I can confirm that I have read the SCHN Fees for the Review of Ethics and Site Specific Assessment Applications Policy and agree to accept the fee for review as per that policy if applicable for my application. Name of Person Submitting the Application: Authorised By (name and position): (Please note that the authorising person (e.g. Principal Investigator) must be cc’d into the email. This will be accepted as having been signed) Date:
Please provide a statement on the following relating to the current progress of the study. Recruitment to Date: (i.e. On / not on target etc. ) Budget: (i.e. on budget, above, below etc.) Safety and adverse events: (i.e. within expected ranges, higher than expected etc.) Does the amendment involve the addition of any procedures involving ionising radiation? If yes, please consult the Radiation Safety Officer prior to submitting your application and provide their report with your application. Please list all documents being submitted with version control information: i.e. TITLE, Version xx, Date DECLARATION: By submitting this application for amendment I can confirm that I have read the SCHN Fees for the Review of Ethics and Site Specific Assessment Applications Policy and agree to accept the fee for review as per that policy if applicable for my application. Name of Person Submitting the Application: Authorised By (name and position): (Please note that the authorising person (e.g. Principal Investigator) must be cc’d into the email. This will be accepted as having been signed) Date:
amendment_form.docx