Change Control Request

General Information

Project Name Date

Client Name Client Company Name

Contact Phone Email Fax

Project Manager Phone Email Fax

Change Request Definition

Description – Describe the proposed change.

Justification – Justify why the proposed changes should be implemented.

Impact of Not Implementing – Explain the impact if the proposed change is not implemented.

Alternatives – Provide at least three alternatives that could be implemented instead of the proposed change.

Change Request Analysis

Check each that apply

Project Schedule Configuration Item Contract Amendment/Change Order
Project Costs Project Scope Major Deliverables/Outcomes
Technology Roles/Responsibilities

Note: An approved Change Control Request MUST accompany the Contract Amendment and Change Order Approval if
applicable.

Impact Description – Describe the impact for each of the items checked.

Texas Project Delivery Framework

Change Control Request 1.0 1
Change Request Initial Review

Review Date Reviewer’s Name Reviewer’s Project Role Recommendation

Approve
Reject
Defer Until: [DATE]

Approve
Reject
Defer Until: [DATE]

Rationale for Recommendation – State the rationale for recommendation.

Change Request Final Management Approval

Final Approval Date Name Title Recommendation

Approve
Reject

Special Instructions – Provide any additional information regarding the final recommendation.

Texas Project Delivery Framework

Change Control Request 1.0 2