Name of the Student

Registration No.

Email address

Mobile No.

Gender

Department

Year

Grievance Column

In the space below, state your grievance. Be as specific as possible. If this is an academic grievance (including a grade appeal), please give the faculty’s name, and department.

Respondent

Please indicate the type of grievance

Academic Grievance

Type of Academic Grievance

Non-Academic Grievance

Type of Non-Academic Grievance

Discrimination

Type of Discrimination

State your Grievance

Be as specific as possible. If this is an academic grievance(including a grade appeal), please give the faculty's name and course.

Please state the remedy you are seeking

If you are confused leave this space blank

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