Change Request
[Project Name]

[School / Section / Unit Name]

[Sub heading as required]

Prepared by:

[Author] / [School/Division] / [Department]

[Status] – [Version] – [Date]

Project Information

Project Number

Project Name

Date

Project Ownership

Project Contacts

Name	Position	Phone	Email
Primary
Other
Other

Project Approval

Document Path

Version Control

Version Number	Date	Reason/Comments/Approval

Description of Request with Reason(s)

Changes in Key Project Areas

Category	Reason for Variance from Project Plan	Proposed Change (Against Project Plan)
Scope
Time
Cost
Quality
Risk Management
Communications

Project Plan to be Reviewed and Suitably Modified?

Disposition of Change Request

Date of Decision	Approved Y/N?	Reason for Approval or Rejection	Resulting Action