Date of Complaint  *

Enrollment Number  *

Full Name of Student  *

Gender  *

Category  *

Person with Disability(ies)  *

Faculty  *

Department  *

Course (Example : B.Sc/M.Sc/Ph.D)  *

Current Semester  *

Mobile Number  *

Email  *

First date on which the events or issues occurred  *

Name(s) and designation of the persons involved  *

Detailed description of complaint  *

Attempts made to resolve this complaint till date  *