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1. Project Change Request Form
Purpose
The purpose of this tool is to standardize all Project Change Requests so that we can
evaluate and prioritize requests appropriately to facilitate delivery.
Change Requester Information
Department: Priority: High Med Low
Contact Name: Contact Email:
Project Sponsor: Date:
Project Title
Communicate which project you would like to change the scope for.
Scope Changes
Briefly document what deliverables you would like to add to the project plan and discuss the
benefits and value that this change adds to the project.
Impact of Non-Completion
Should resources not be available for this scope change, describe how the business will be
impacted by non-completion of this proposed amendment.
Impact on Project Timelines
Estimate how this change in scope will affect project timelines and end date.

2. Additional Resources Required
• What resources will be required to complete this portion of the project?
• What is the estimated cost to add this deliverable into the project?
Project Change Request Approval (required signatures)
Change Requester: Project Sponsor:
Date: Date:
Name: Name:
Signature: Signature:
Project Manager:
Date:
Name:
Signature: