City of Philadelphia: Project Intake Form

Project Name:

Requesting Department / Agency name: :

Project Start Date (Est.):

Project End Date (Est.):

Proposed Funding Source:

(CapEx/OpEx/Grant/Other)

Estimated Cost (if known):

Project Name:

Executive Summary:

[Briefly summarize the proposed project including key agency objectives and anticipated benefits to support your request for this project.]

Business Case:

[Explain the business problem that you are trying to solve / the business drivers for this project). Basically, why is this project being done? What is the scope of the project?]

City Goal Alignment Identify which of the major city goals this project supports. More than one choice is allowed:

Philadelphia becomes one of the safest cities in America
The education and health of Philadelphians improve
Philadelphia is a place of choice
Philadelphia becomes the greenest and most sustainable city in America
Philadelphia government works efficiently and effectively, with integrity and responsiveness

This request has been reviewed and approved by the IT Director/Manager for this Department
This request has been reviewed and approved by the Department head or their delegate

List the Name of the approver:

List the title of the person listed.:

Use the format mm/dd/yy, to document the date the request was submitted to this individual for approval:

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