Franklin Pierce University

Institutional Review Board

Extension Request Application

Note: Approved IRB proposals will expire one year from the approval date. Application to the Chair for an extension must occur two months prior to the expiration date (per current IRB policy).

Principle Investigator Name:

Study title:

Date of Prior Approval:

Reason for extension request:

Length requested for extension (one year maximum):

Will there be any changes to the already approved study? If so, explain the changes in detail and why they are necessary.

_______________________________ _______ Approved ____ Not Approved ____

Chair-Signature	Date

IRB Approval #: ____________________________ Approval Expiration Date: ____________________