Application Change Form

Deadline for Application Change requests is 12:00noon, Wednesday for Sunday of the following week (11-days).
Unless Approved by the Environment Team (ET) otherwise, all changes will be scheduled between
12:01AM and 10:00AM on Sundays.
Instructions:
● All checkboxes with bold text labels must be filled in as confirmation of review (Enter "n/a" in text field if not applicable)
● Worksheet is protected, please use Tab key to move to next available unprotected cell; Checkboxes and radio buttons are
accessible using the mouse.

Application: Requestor: Change By Date/Time: Request #:

Change Description:

Purpose/Reason:

Impact to Customers/Users (downtime, etc):

Downtime communicated to customers (required if downtime)

Network Operations notified to turn off NAGIOS alerts during downtime (required if downtime; NOC@lausd.net)

Notes/Special Instructions:

Initial Environment:
Prod Stage Train Test Dev Other:

Version (Application): Release:

Target Environment:
Prod Stage Train Test Dev Other:

Impact:
Application CSM Database Report Other:

Pre-ET* Required Tasks: Attachments:

Procedure Script Architectural Diagram
System/QA Testing Protocols & Standards
User Acceptance Testing Release Notes
Release Notes Security Document
Security Code Scan Other:
Package Installation Testing Other:
User Communication/Training None
Other:
* ET= Environment Team

Authorization/Sign-off**:
** Email confirmation is acceptable authorization/sign-off; All authorizations are mandatory

Business Sponsor: Date: Technical Project Manager: Date:

Printed Name Printed Name

Security: Date: ITD Director: Date:

Printed Name Printed Name

ITD Environment Change Mgmt.xls / Form AC-1 Page 1 of 1 Updated: 01-31-2007