Change Request Approval Form

CHANGE REQUEST FORM

Project: Date of Request:

Requester:(Name and Title) Change Request ID:

Type of the Change:

☒ Scope   ☐ Human Resources ☐ Procedure/ Process ☒ Schedule
☐ Others: Please specify _________________
Description of the Change:

Priority
☒ Critical (I can’t move forward until this change is made)
☐ High (The situation is fine right now, however, the change has to be made as soon as possible, otherwise I can’t  move forward.)
☐ Medium (It’s not urgent, but the change will have to be made in the near future)
☐ Low (This change is not affecting my ability to move forward with the project.
Change Duration： Proposed  Start Date:

Proposed  End Date:

Reasons for the change:

Impact of the change: ☒ Variation ☐ Over-run

☐ Other, State__________________________________________________________________________________________________
Provide any additional information:

Alternatives to the Change:

Description of the possible risks:

Estimated costs and resources required to implement the change:

Outcomes of the project:

_____________________________________________________
Requester Signature

Position: ______________________________________________
Date:

FOR OFFICIAL USE ONLY

Change Request Status:

      ⃞  Request approved         ⃞  Request rejected             ⃞  Delayed

Comments on the status:

Approving party:

_____________________________________________________
Signature

Name:

Position: Project Manager

Date:

Managing Director

_____________________________________________________
Signature

Date: