Central University of Haryana
Intranet Complaint Form
Full Name:
*
Prefix
First Name
Last Name
Father Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Category
*
Please Select
Employee
Student
Building
*
Department:
*
E-mail:
*
Phone No.
*
Problem Category:
*
Computer
Email
Network
Phone
Other
Please specify
*
Snap Shot of problem
Upload a File
Cancel
of
Date
*
-
Month
-
Day
Year
Date Picker Icon
Comment and Questions:
*
Enter the message as it's shown
*
Submit
Clear Form
Should be Empty: