There isn't an example out-of-the-box that I know of that Microsoft provides for this, but you could search for some similar applications on Github.
It looks like University of Washington has something similar to this: https://wiki.cac.washington.edu/display/MSINF/Copy+of+Azure+AD+Application+Request+Fulfillment+Process
The Power Platform has a template for requesting the creation of a Team on Microsoft Teams, and this has a lot of fields that might also be useful in your scenario (business justification, scope, stakeholders, etc). You could use similar criteria for your project: https://github.com/OfficeDev/microsoft-teams-apps-requestateam
You could also browse some of the Microsoft templates for request forms:
https://flow.microsoft.com/en-us/galleries/public/templates/d44aa307004c479ba928dddb604790fd/submit-a-microsoft-form-to-get-approval-and-add-a-contact-to-txtsync/