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CHANGE REQUESTProject Title:Date Prepared:Person Requesting Change:Change Number:Category of Change: Detailed Description of Proposed ChangeJustification for Proposed ChangeImpacts of ChangeScopeDescription:GradeDescription:CHANGE REQUESTRequirementsDescription:CostDescription:ScheduleDescription:Stakeholder ImpactDescription:Project DocumentsCommentsCHANGE REQUESTDispositionJustificationChange Control Board SignaturesNameRoleSignatureDate:Page 3 of 3