Request Submission Information:

Project Name:

Name of Authorized Requestor: Date requested: __/__/____

Title of Authorized Requestor: Request Number

Department/Division:

Description of change requested

Expected benefit of the change

Stakeholder Value Added Description Value-Added Amount

Implementation Requirements

Cost of Implementation Low High

1.

2.

2.

4.

Total $ - $ -

Return on Investment

Annual savings (revenue enhancement or cost reductions) $ -

Cost of implementation

1st Year Savings $ -

#DIV/0!

Person authorizing the request Associated signitureAuthorizor's Name Authorizor's Signiture

Project Change Request Form (template 1)

Return on Investment (1st year) (1st year savings devided by cost)

Below are the definitions of the information to be placed in each field of the Project Change Request Form.

Product Definition:

Request Submission Information:Project Name:Name of Authorized Requestor: Date requested:Title of Authorized Requestor: Request NumberDepartment/Division:

Description of change requested

Expected benefit of the changeStakeholder Value Added Description

Implementation Requirements

The Project Change Request is the first part of a 2-part packet designed to support the evaluating and tracking of a suggested modification to a project's scope. The Project Change Request contains information provided by the person making the request. The 2-part packet goes through three phases. The first phase is the "Request" phase, the second phase is the "Impact Analysis" phase and the third phase is the "Approval-Denial" phase. The 2-part packet is designed to drive the change request process and to become a permanent record of each specific request.

Project Change Request Form

Describe the details of the change being requested. Be sure to attach examples of any screens or reports that are part of the request. Explain why the change is justified. Be as specific as possible. Focus on benefits and the value the change provides to the organization.

Place the name of the Stakeholders or Stakeholder Groups here (Sales, customer, owners, etc.).

Describe with as much detail as possible how this change benefits each Stakeholder listed. Add attachments if needed.

Describe any implementation requirements you are aware of such as training, scheduling, equipment purchases and all related time tables. If specialists are needed be sure to identify them and the role they are expected to play in the effort.

Cost of Implementation1. Detail each cost component of the change. Provide the description on the lines2. provided (add attachments if needed).2.4.

Return on Investment

1st Year Savings

Return on Investment (1st year)

Authorizor's Name Authorizor's Signiture

Annual savings (revenue enhancement or cost reductions)Cost of implementation (average of above total)

Below are the definitions of the information to be placed in each field of the Project Change Request Form.

Date requested: __/__/____ >>

Request Number

Value Added Description Value-Added Amount

The Project Change Request is the first part of a 2-part packet designed to support the evaluating and tracking of a suggested modification to a project's scope. The Project Change Request contains information provided by the person making the request. The 2-part packet goes through three phases. The first phase is the "Request" phase, the second phase is the "Impact Analysis" phase and the third phase is the "Approval-Denial" phase. The 2-part packet is designed to drive the change request process and to

These fields are self explanatory

Describe the details of the change being requested. Be sure to attach examples of any screens or reports that are part of the request. Explain why the change is justified. Be as specific as possible. Focus on

Describe with as much detail as possible how this change benefits each Stakeholder listed. Add

Enter the dollar value benefit of the change for each Stakeholder listed.

Describe any implementation requirements you are aware of such as training, scheduling, equipment purchases and all related time tables. If specialists are needed be sure to identify them and the role they

Low High

Detail each cost component of the change. Provide the description on the lines Enter Enterthe low the high

estimated estimated

cost cost

Total $ - $ -

$ - 0

1st Year Savings $ -

Return on Investment (1st year) #DIV/0!

Authorizor's Signiture