Student Grievance Appeal Form - K L Deemed to be University

Name of the student

Student Id Number

Branch

Year of Study

Mobile Number

E-Mail Id

Status of the Student

Did you seek information or assistance before making a complaint?

Yes

No

Staff member(s) or Committee from whom have you already sought a resolution about this

Name

Position

Nature of complaint

Ragging

Discrimination

Sexual Harassment

Other

Outline of the original complaint

Describe the most recent resolution offered

From whom did you receive the final notification of the resolution, and when?

Name

Position

Date

State what outcome(s) you are seeking from this appeal

Comments/Suggestions