Grievance form for Students – Dinsha Patel College of Nursing

DINSHA PATEL COLLEGE OF NURSING

Managed by Mahagujarat Medical Society, Nadiad

College Road, NADIAD-387001. Phone: 0268-2521500 Email: dpcninfo@yahoo.com www.dpcn.org.in

Student Grievance Form

Name of Student

Mobile number

Student Email

Program/Courses

Academic Year

Class

Area of Grievance

Date of indecent or Problem

Name of individual and / or department against whom the grievance is filed:

Describe your grievance/complaint in detail including date/time of occurrence with necessary specifications. Attach additional sheets if necessary, along with any documentation that will help describe and substantiate the complaint. If any witnesses are there, list names and contact details.

I hereby declare that the information on this form is true, correct and complete to the best of my information and belief. I understand that Grievance information may be shared with college officials in order to conduct through investigation and any misrepresentation of information may result in disciplinary action, in accordance with college disciplinary policies.