SUSIL KUMAR INSTITUTE OF ENGINEERING AND TECHNOLOGY

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Student Full Name

Admission / Roll No.

Class

Section

Academic Session

Transport (College Bus)

Parent/Guardian Name

Relationship

Contact Number

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Alternate Contact

Email Address

Address

City

State

PIN Code

Confidential?

Yes No

Nature of Grievance

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Sub-Category

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Date of Incident

Time of Incident

Location

Persons Involved (if any)

Impact Level

Expected Resolution Time

Description of Grievance

Previous Attempts to Resolve

Desired Outcome

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I declare the information is true and correct. I understand that false information may lead to dismissal of the grievance.

Parents Grievance Form