Formulier klacht bezwaar of beroep

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- Complaints and disputes

Form for submitting complaints, objections or appeals

Required fields are marked with an asterisk (*)

Personal Information

First name*

Insertion

Surname*

Date of birth (dd-mm-jjjj)*

Contact information

Student ID number*

Address*

Zip code (1234 AA)*

Town/city*

Country*

Telephone number*

E-mail Adress*

Description of situation

Describe what happened (e.g. when you received a letter from the Examinations Committee or the Department Board) and explain why you do not agree with it. If applicable, enclose the decision

Have you already discussed the problem with someone from ESA or the department*

If yes, describe here what happened

Add if applicable, the decision

I will consider the situation satisfactorily settled, when....

Don't fill this field!