Draft Project Change Request Form Page 6

Section 5: Proposed Change - Decision and Resolution

Approved or Denied? Project Name:

Change Request #:

Requestor:

Authority/ Approver(s) and Role:

Date:

Governance Authority Signature:

Reason for Approval or Denial:

IF APPROVED continue below -

Modification to the Change Request (if any):

Effect on Project Scope, Milestones or Deliverables:

Number additional Resources:

Hours of additional Effort?

Impact on Project Schedule:

Risk Impacts:

Cost in Dollars:

Project Budget Impact:

Comments:

Section 6: Project Manager Plans and Documentation Tracking

Project Manager:

Signature:

Date:

Project Managers signature above indicates project plans are updated, and requestor is informed

of the decision.

10/30/14

Version 1.0

Page 6

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Parent category: Business