Name Email Phone Type of Grievance: (Select One) Academic Issue Administrative Concerns Harassment or Discrimination Facilities and Infrastructure date Location of Incident/Observation: Description of Grievance: Upload Relevant Document if Required Please describe your desired outcome or resolution for this grievance: I would like to receive an acknowledgment of my grievance submission via email: Yes No I understand and agree that the information I provide will be treated confidentially and only shared with the relevant authorities for the purpose of resolving my grievance: Yes No Signature (Type your full name to acknowledge the submission of this form): By submitting this grievance form, you confirm that the information provided is accurate and true to the best of your knowledge. Misrepresentation of facts may result in further action.
