MARIANO MARCOS STATE UNIVERSITY Document Code URERB-FRM-017

University Research Ethics Review Board

Revision No. 0 Page 1 of 1
Effectivity Date August 28, 2019
PROTOCOL AMENDMENTS OR CHANGES FORM

REVIEW ON PROTOCOL AMENDMENTS OR CHANGES

Protocol Code* Date of Submission*

Date of Approval

Study Protocol Title

Page and
Paragraph Remarks of the
List of Changes/Amendments Reason/s
where it can be Reviewers
found

Recommendation:

Decision:
Approval
Minor Modification prior to approval
Major Modification prior to approval
Disapproval

_________________________
Signature of Primary Reviewer