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ExHIBIT A: CHANGE REQUEST FORM <br />GENERAL INFORMATION <br />Change Request M (C R) <br />ProlecUCirylCnunty <br />Requestor Name <br />Description of Change <br />Date Submitted <br />Prionry <br />Reason for Change Request <br />Project Artifacts Impacted <br />Assumptions.Risks <br />Commentu Co nsideratons <br />Atmctiments' References <br />Avulve Software Change Request Form <br />Giy ajSnmewAne <br />(Enter a derailed description of the change being requested] <br />Low Medium High Requred <br />[Enter a detaded description, of why the change is being requested] <br />[List other arhfects affected by this change] <br />(Document assumptions rm comments tegstdirg the requested change] <br />[Enter add3ronaf commentaj <br />ESTIMATES <br />Total Estimated Development Hours <br />Total Estimated Development Duration <br />Sthemuie Impact <br />Cost Impact <br />CammentslRecommendacons <br />PM Approval Signature <br />scat, agree <br />IDS Approval EggrarYtte <br />i <br />[Enter the hour vnpact of the requesed charge] <br />Pa lod dlangeJ <br />j7Fttyasj I [Ether the duratan dm d o! the reques <br />n�S] IDetadVia impactthachomp Mayhew on <br />schedules] J <br />[Cost] jDaNd the impact thin change mayhase on cost(_ _J <br />Dale Signed <br />C" OF SOMEWHERE AUTHORIZATION <br />Customer Approval Signature <br />it , —'I <br />AVMI seftmm ol"olr2ol5 Page t of 1 <br />25E-24 <br />