Student’s Name: ---------------------------------------------------------- Mobile : ______________

Fathers/Guardian’s Name ---------------------------------------------- Mobile_________________

Residential Address __________________________________________________________

Class : -------------------------- Div : ---------------- Roll No ------------

Email ID ----------------------------------------------------------

Permanent Address ___________________________________________________________

FNature of Grievance: Academic /Administrative /other _________________________________
Date, Time and place of event leading to grievance:

Grievance Details ___________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
State Policies, guidelines or procedures you think have been violated
__________________________________________________________________________________
Proposed solution to grievance
__________________________________________________________________________________
__________________________________________________________________________________
State why do you think an informal resolution is not possible

The information that I am submitting here is factual and without any exaggeration
Signature ------------------------------- (signature of the student)
Note : Fill all the details in the form send it to studentgrievance@fergusson.edu , attach the necessary document s
and submit the hard copy to college office