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Student Grievance Appeal Form

Name of the student
Student Id Number
Year of Study
Mobile Number
E-Mail Id
Status of the Student
Did you seek information or assistance before making a complaint? Yes No

Staff member(s) or Committee from whom have you already sought a resolution about this

Name Position

Outline of the original complaint

Describe the most recent resolution offered

From whom did you receive the final notification of the resolution, and when?

Name Position Date
State what outcome(s) you are seeking from this appeal