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Shri Shivaji Science & Arts College, Chikhli, Dist. Buldana(M.S) 443201
Internal Complaints Committee(ICC)
Proforma for Filling of Complaints of Sexual Harassment
* Indicates required question
Name of the Complainant (Student/Academic Staff/Non-Teaching Staff)
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Your answer
Age of the complainant
*
Your answer
Address of the complainant
*
Your answer
The Complaint
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Your answer
Phone number of the complainant
*
Your answer
Email of the complainant
*
Your answer
Name of the person against whom the complaint is being lodged
*
Your answer
Age of the person against whom the complaint is being lodged
*
Your answer
Sex of the person against whom the complaint is being lodged
*
Your answer
Address of the person against whom the complaint is being lodged
Your answer
Phone number of the person against whom the complaint is being lodged
Your answer
Email of the person against whom the complaint is being lodged
Your answer
Additional details of the complaint may be recorded here
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Your answer
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