Student Enroll Number *

Date of Grievance Form *

Student First name *

Student Middle name *

Student Last name *

Select Faculty: ----- Select Faculty ----- Science (Required)

Select Course Name: ----- Select Course ----- (Required)

Select Learning Year: ----- Select L. Year ----- (Required)

Select Category of Grievance: ----- Select ----- Examination Infrastructure General Facilities Library Sports Health and Hyagine Admission Sexual Harrashment Teaching Learning Office Administrator Discipline Ragging Code of Conduct Any Other (Required)

Academic Year: ----- Select ----- 2017-18 2018-19 2019-20 2020-21 2021-22 2022-23 2023-24 2024-25 (Required)

Roll No. *

Select Gender: ----- Select ----- Male Female (Required)

Email address * Enter valid email address!

Mobile No. * Input valid Mobile No.!

Student Grievance description *

Declaration
I here by declare that the information provided above is correct. I shall be responsible for furnishing any wrong information.
    I agree with all terms and conditions.