Project Change Form

Instructions

The purpose of the Project Change Form is to document changes that have occurred during the implementation of your project. As a Recipient, if there are changes to your project, you should fill out the relevant sections of the form and send a copy to your Program Officer. The Program Officer will then review the form and assess the impact of those changes before determining the next steps.

To complete the Project Change Form, please download the MSWord file provided. Once you have downloaded the file, please add the details of your changes and complete the Recipient Declaration. Once complete, please email an electronic version to your Program Officer.

Text from the form including some examples may be found below.

MS Word version
(52 KB, 2 pages)

Information on Downloading a Word Viewer

Part A

Recipient Name:

Project Number:

Name of Recipient Contact:

Date Requested:

Description of the change:

  • Refer to your CA section / paragraph / page (e.g. equipment list on page 90 line 64)
    • Example 1: move project site XYZ from longitude A latitude B to longitude C and latitude D
    • Example 2: replace equipment identified as ubiquity model ABC for Cambium model XYZ for lines 13,17,45,85 of equipment list

Business or technical justification for change:

  • Example 1: could not secure originally intended site through negotiations with landlord
  • Example 2: Cannot get proposed equipment (not manufactured anymore), proposing to change for equivalent technology

Impact on the project:

  • Example 1: Impact of moving project site (e.g. coverage impact, physical access to new site, any increased or decreased risks this would imply)
  • Example 2: Impact of changes to equipment (e.g. increased cost, technological impact on coverage or quality of service, bandwidth)

Recipient Declaration (to be completed by the Recipient)

By signing this document, the Recipient acknowledges and agrees that the request to change to the Contribution Agreement as specified in Part A of this form is subject to the approval of the Minister and if so approved by the Minister as demonstrated by signing Part B of this form shall become legally binding.

The Recipient further acknowledges and agrees that all provisions of the Contribution Agreement remain in full force and effect, except as modified by this form.

space to insert name / title
Replace with name of Recipient signer
Replace with signers title
Please remove this textbox once Part A has been completed. Please change the recipient signers' name and title. Also, please type your name or insert an image representing your signature.

Comments:

Part B

Impact Assessment (to be completed by IC)

  • ◻ Amendment Required (PAF Required)
  • ◻ No Amendment Required

Program Officer Name:

Engineer Name:

Change Impact Assessment:

Impact on project parameters:

  • ◻ Budget
  • ◻ Sites
  • ◻ Equipment
  • ◻ Risk Profile
  • ◻ Project Schedule

Program (if applicable)

  • ◻ Project Schedule Updated
    Date:
  • ◻ Risk Profile Updated
    Date:
  • ◻ Budget Profile Updated
    Date:
  • ◻ Other: (specify)
    Date:

Engineering (if applicable)

  • ◻ Equipment List Updated
    Date:
  • ◻ Site List Updated
    Date:
  • ◻ Other: (specify)
    Date:

Decision/Recommendation (to be completed by IC)

  • ◻ Approved
  • ◻ Rejected

Program Officer Name:

Print Name:

On this Date (YYYY-MM-DD):

Signature:

Title:

Engineer Name:

Print Name:

On this Date (YYYY-MM-DD):

Signature:

Title:

Comments: