Cornell Project Management Methodology (CPMM)

CPMM Change Order (Internal)

(Not to be used for outside suppliers/contractors)
PROJECT NAME: Requested by:
Functional Area (Customer): Impact Level:
Change Order Number: Log Date:
Status: <Proposed, Authorized, Denied, Deferred>

Authorization for the following changes:

Description Amount
Change Description
Benefits Description
Alternatives
Impact Analysis Statement
(describe any changes to the scope,
time or cost of the project )

Reference any attached details or estimates:

Not valid until signed by Service Provider and Customer:

The original “Amount” was $

Net change by previously authorized Change Orders $
The “Amount” prior to this Change Order was $
The “Amount” will be (increased/decreased/unchanged) by this Change Order $
The new “Amount” including this Change Order will be $
The project time will be (increased/decreased/unchanged) by ( ) days.
The new estimated date of completion therefore is:

AUTHORIZED SIGNATURES (Add Signatures as required by your project):

Functional Area (CUSTOMER) Department (SERVICE PROVIDER)

BY BY
Signature Signature

NAME NAME
Please print Please print

TITLE TITLE

DATE DATE

Footnote: If this is committing University funds not already approved, please make sure you follow standard
signature authority at Cornell.

CPMM Change Order (Internal) 1 Appendix 4-2

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