Date of Variation Submission
Research Submission ID	Field to be completed by AIS Ethics Committee Secretary
Ethics Approval Number
Project Title
Principal Researcher

What section(s) of the approved AIS Ethics Committee submission form does the amendment fall under?

What is the proposed amendment?
In one or two paragraphs, state the amendment and how it differs from the original proposal. E.g. The researchers wish to include a test to measure…

What is the justification behind the amendment?
Give reasons for the amendment and a little more detail on what is involved.

Please describe what you believe the ethical implications of this amendment are:
Please refer directly to the NHMRC guidelines in your response:

Signed:	Date: ___/___/___

Principal Researcher

Signed:	Date: ___/___/___

Head of Department