Project Change Request Form [Insert Project Name] Last Updated: [insert date] Template-Change Request Form v2 11-10-04 1 Change Request Number Date Requested Requested By [Enter the Change Request Number] [Enter the current date] [Enter who is requesting this change] Change Request Description [Describe the change] Business or Technical Justification For Change Request [Describe why implementing this change is important] Priority □ Top □ High □ Medium □ Low Impact of Not Making the Change [Describe what would happen if this change request was not implemented] Change Impact Analysis Impact on Project Requirements □ In Scope □ Out of Scope Impact on Project Objectives [Describe what the impact of this change request would be on the project objectives] Impact on Project Technical Architecture [Describe what the impact of this change request would be on the project technical architecture] Impact on Project Deliverables [Describe what the impact of this change request would be on the project deliverables] Impact on Project Risk [Describe what the impact of this change request would be on the project risks] Impact on Project Schedule [Describe what the impact of this change request would be on the project schedule] Impact on Project Budget Projection [Describe what the impact of this change request would be on the project budget projection] Options for Resolution [Describe what options exist to implement the change request] Project Change Request Form [Insert Project Name] Last Updated: [insert date] Template-Change Request Form v2 11-10-04 2 Recommendation [Enter the recommended option for resolving the change request] Project Change Request Form [Insert Project Name] Last Updated: [insert date] Template-Change Request Form v2 11-10-04 3 Change Request Resolution Change Request Decision □ Approved □ On Hold □ Denied Decision Date Decision Made By □ Project Manager □ Project Sponsor □ Executive Sponsor □ Other Reason for Decision