Project Change Request Form

The Project Change Request Form is used to request approval of changes of strategic
significance in a project from its Steering Committee. Because projects are dynamic and
changes are inevitable, good project management ensures that the changes are
recognized, documented and dealt with at the right level. Every change should have a
separate request form.

Project Information

Project Name: <Project Name>
Project Number: <Project Number if applicable>
Date: <MM/DD/YYYY of change request>
Prepared by: <Name, title>
Distribution List: <Names>

Description of Request with Reason(s)

Here is where you write a full description of the change request and the basis for the
change. Include expected outcomes and benefits.

Changes in Key Project Areas

Fill in the table below showing the changes needed across the specific key project areas
and the adjustments within each area to accommodate the requested change.

Category Reason for Variance from  Proposed Change

Project Plan (Against Project Plan)
Scope
Time
Cost
Quality
Risk Management
Communications

Review and Modification of Project Plans

Indicate yes or no. If yes, give details, including time frame, etc. If no, give reason(s).

Disposition of Change Request

This section should be completed by the Steering Committee or PMO. Indicate the
decision on the request for change and resulting actions. This information is for tracking
purposes.

Date of Decision Approved Reason for Approval or Resulting Action

Y/N? Rejection
gantthead.com Project Change Request Form

Date of Decision Approved Reason for Approval or Resulting Action

Y/N? Rejection

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