3-4-1 Purpose
The purpose for this document is to request authorization to implement a change. Please provide the requested information with sufficient detail that the Change Control Board can make the correct decision.

3-4-2 Copyright
Summer 2004, Irvine, California, USA, copyright by Robert E. Perrine, PMP. Offered as is, with no warranty regarding the accuracy or suitability of this material. Copyright reserved. You are, however free to copy and distribute these documents with the following restrictions.

• You may not charge for use or distribution of this material.
• Your usage of this material is conditioned upon your compliance with the PMI Code of Ethics.
• All distributions must be made with the intent to further the collected wisdom of humanity.
• You may not remove my name or my copyright notices from these documents.

3-4-3 Table of Contents
Recursion Project
3 Communications
3-4 Change Requests
3-4-1 Purpose
3-4-2 Copyright
3-4-3 Table of Contents
3-4-3 Change Request Form
3-4-4 Change Approval
3-4-5 Change Results

3-4-3 Change Request Form

Name for this Change
Change Number
Submitted by
Date submitted
Reason for the change
Describe the change
Expected results
Describe the impact this change will have on the project duration
Describe the impact this change will have on the project budget
Describe the impact this change will have on the scope of work
Describe the impact this change will have on quality
Comments

Once the change is authorized, schedule a change window. Record the results in the “Change Results” section.

3-4-4 Change Approval
The Project Manager has authority to authorize changes where he/she is confi dent that the project will still complete on-schedule, within budget and without detrimental effects on the scope and quality of the product. The Project Manager also has authority to execute an emergency change is the situation requires such action. Emergency changes must be reviewed at the next scheduled meeting of the Change Control Board.

All other changes must be submitted to the Change Review Board for authorization.

Date	Authorization or Rejection with explanation

3-4-5 Change Results

Planned Date / Time
Actual Date / Time
Implementer’s Name
Status
Results
Lessons Learned