Online Students' Grievances Registration System

Student's Registration No.
(Enter Your Valid Student ID)

Date of Birth
(Select Year & Month first and then date finally)
Name of the Student
Campus
Batch
Programme Name
Email ID *
Whether you would like your email ID to be shown in Receiver's mail, which would enable to send reply to you * Yes No
Grievance Category *
Grievance Detail *
(Max. 500 Characters)
Security Code
(*)  Mandatory Fields