Application for Renewal and Protocol Amendment | Center for Cognitive and Behavioral Brain Imaging

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Guidelines for Submissions of Requests for Renewal and Protocol Amendmentto the Center for Cognitive and Behavioral Brain Imaging Proposal Review Committee Committee CompositionRuchika Prakash, Director, CCBBI (Chair)Xiangrui Li, Assistant Director, CCBBIMichelle Failla, Assistant Professor, College of NursingJulie Golomb, Professor, College of Arts and SciencesKristen Hoskinson, Associate Professor, Nationwide Children's HospitalKristen Lindquist, Professor, College of Arts and SciencesDylan Wagner, Associate Professor, College of Arts and Sciences Terms of UsageAll studies require pre-approval by the Proposal Review Committee prior to scheduling scan time. How to Apply for Renewal and Protocol AmendmentsTo submit a request for renewal and/or protocol amendments to your funded study, please complete the application below. If you prefer to fill out a PDF form, please send a request to ccbbi.service@osu.edu Your submitted request will be reviewed by members of the CCBBI Steering Committee. The reviewers may ask questions or provide feedback prior to the approval. You will receive a response of approval via email, typically within two weeks.

Title of Project or Study

IRB Protocol #

Original study start date

Original study completion date

Original number of funded scanning hours for study

Original number of participants for study

Are you requesting a change in protocol?

If yes, please go to Box A

Are you only requesting additional hours?

If yes, please go to Box B

Are you only requesting an extension of end date?

If yes, please go to Box C

Box A: to be completed if you are requesting a change in protocol

Date of prior approval

Name of previously approved Scan card

Are the participant sample characteristics the same as before?

Are the stimulus presentation requirements the same as before?

Are the equipment needs (eyetracker, headphones, etc.) the same as before?

Are the testing room requirements the same as before?

Are the sequence types (EPI, DWI, etc.) the same as before?

Description of new study

Briefly describe how this new study differs from the previously approved study. Please include the changes in number of participants, description of stimulus changes, sequence length changes, etc.

Box B: to be completed if you are only requesting addtional hours

Briefly describe the reasoning for additional hours and provide how many additional hours are needed.

Box C: to be completed if you are only requesting an extension of end date for the project

Briefly describe the reasoning for an extension of end date and provide updated end date for the project.

Box D: to be completed by everyone

Personnel

Please upload a list of all personnel assisting in the study's MRI component. Please provide names, degree held, and email.

One file only.
5 MB limit.
Allowed types: gif jpg png pdf doc docx ppt pptx xls xlsx zip.