Dr. Rammanohar Lohia Avadh University

Date of Complaint

Enrolment No.

Full Name Of Student(as enrolled)

Gender

Category

Person with Disiability

Faculty/Institute/College

Department

College

Course (Eg.-B.A.,M.A.,B.Sc.,M.Sc. etc)

Current Semester

Email Id

First Date on which the events or issues occured

Name and Designation of the person involved

Detailed of discription of complaint

Attempts made to resolve this complaint up to now (Please state who you contacted and what response you have you got)

2 + 4 =