diff --git a/.github/pull_request_template.md b/.github/pull_request_template.md
index cba993b..597c790 100644
--- a/.github/pull_request_template.md
+++ b/.github/pull_request_template.md
@@ -27,6 +27,53 @@ Fixes # (issue)
 - [ ] Doc/Design
 - [ ] Unit test
 
+### Back port request
+<!--
+Only check a release or feature branch when the PR links a GitHub issue or ADO
+work item above. The linked tracker should explain the failure in detail,
+including whether it is a day-one issue or a regression, the affected
+branch/image/platform/test, and why this branch needs the fix. Backport or
+cherry-pick requests without a linked issue/work item may not be favored.
+
+If you request a backport/cherry-pick, provide both:
+1. A GitHub issue or Microsoft ADO work item tracking the change.
+2. Test evidence from the target branch(es) requested below.
+-->
+- [ ] 202305
+- [ ] 202311
+- [ ] 202405
+- [ ] 202411
+- [ ] 202505
+- [ ] 202511
+- [ ] 202605
+
+Tracking issue/work item for backport/cherry-pick request (GitHub issue or Microsoft ADO):
+Failure type: <!-- day-one issue / regression / other -->
+
+### Tested branch
+<!--
+Select each branch where the change was tested. If you request a
+backport/cherry-pick, select the base branch and the tested target release
+branch(es).
+-->
+- [ ] master
+- [ ] 202305
+- [ ] 202311
+- [ ] 202405
+- [ ] 202411
+- [ ] 202505
+- [ ] 202511
+- [ ] 202605
+- [ ] N/A
+
+### Test result
+<!--
+Provide the tested image version and test evidence for each selected branch.
+For example:
+- master: 20260716.01 - <test result or link>
+- 202605: 20260531.42 - <test result or link>
+-->
+
 ### Approach
 #### What is the motivation for this PR?
 
@@ -36,6 +83,10 @@ Fixes # (issue)
 #### How did you do it?
 
 #### How did you verify/test it?
+<!--
+Summarize the overall validation here. For a backport/cherry-pick request,
+provide branch-specific image versions and evidence in the Test result section.
+-->
 
 #### Any platform specific information?