Your name

College Roll No

Class Sem

Contact No

Email ID

Mailing Address

Information About Your Complaint

First date on which the events or issues occurred

Name(s) of the persons involved

Please describe your complaint in detail. Include the names of persons, locations, and dates involved. Use additional sheets if you need more space. If this complaint is against a specific person(s), please list their names and titles

Any other information you want to provide?

I hereby certify that the above information is true and correct to the best of my knowledge and belief. I grant permission for this complaint to be forwarded to SRCEM grievance committee officials for purposes of investigation and response.
I agree

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