Form JD-ES-284 "Discrimination Complaint/ Federal Grants" - Connecticut

What Is Form JD-ES-284?

This is a legal form that was released by the Connecticut Judicial Branch - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2018;
  • The latest edition provided by the Connecticut Judicial Branch;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form JD-ES-284 by clicking the link below or browse more documents and templates provided by the Connecticut Judicial Branch.

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Download Form JD-ES-284 "Discrimination Complaint/ Federal Grants" - Connecticut

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DISCRIMINATION COMPLAINT/
STATE OF CONNECTICUT
ADA NOTICE
FEDERAL GRANTS
JUDICIAL BRANCH
The
Judicial
Branch
of
the
State
of
www.jud.ct.gov
JD-ES-284 Rev. 12-18
Connecticut complies with the Americans with
Disabilities Act (ADA). If you need a reason-
Instructions
able accommodation in accordance with the
ADA, contact a court clerk or an ADA contact
A program or activity supported by U.S. Department of Justice funds must comply with federal civil rights
person listed at www.jud.ct.gov/ADA.
discrimination laws. Civil rights complaints may be reported by filing this form with the Director, Human
Resource Management Unit, 90 Washington Street, Hartford, Connecticut 06106, (860) 706-5280 or
by e-mail to Human.Resources@jud.ct.gov. Attach additional documents, if necessary.
Name of person filing complaint
E-mail address
Telephone number
Mailing address (Number and street, or P.O. box; city; state; zip code)
Subrecipient's Name, Address and Telephone Number (A subrecipient is a program or agency that receives funds from the
Connecticut Judicial Branch.)
Does your complaint involve ("x" one):
Employment
Services or Benefits
Does your complaint
Age
Race/Ethnicity
Sex (gender)
involve ("x" one or more):
Religion
Color
Gender Identity
Mental or Physical Disability
National Origin
Sexual Orientation
Describe the alleged discriminatory act (include dates, locations, names and contact information of witnesses - use one or
more additional pages, if necessary.)
Date signed
Signature of complainant (Person filing this complaint)
Do not write below this line.
The complaint is dismissed.
The following resolution is offered and the matter is concluded:
The above resolution has been offered but the matter is not concluded.
The complainant has been told about the federal and state agencies that are available if he or she wants to pursue the
matter further.
Additional comments:
By: (Director of Judicial Branch Human Resource Management Unit or designee)
Dated
Print Form
Reset Form
DISCRIMINATION COMPLAINT/
STATE OF CONNECTICUT
ADA NOTICE
FEDERAL GRANTS
JUDICIAL BRANCH
The
Judicial
Branch
of
the
State
of
www.jud.ct.gov
JD-ES-284 Rev. 12-18
Connecticut complies with the Americans with
Disabilities Act (ADA). If you need a reason-
Instructions
able accommodation in accordance with the
ADA, contact a court clerk or an ADA contact
A program or activity supported by U.S. Department of Justice funds must comply with federal civil rights
person listed at www.jud.ct.gov/ADA.
discrimination laws. Civil rights complaints may be reported by filing this form with the Director, Human
Resource Management Unit, 90 Washington Street, Hartford, Connecticut 06106, (860) 706-5280 or
by e-mail to Human.Resources@jud.ct.gov. Attach additional documents, if necessary.
Name of person filing complaint
E-mail address
Telephone number
Mailing address (Number and street, or P.O. box; city; state; zip code)
Subrecipient's Name, Address and Telephone Number (A subrecipient is a program or agency that receives funds from the
Connecticut Judicial Branch.)
Does your complaint involve ("x" one):
Employment
Services or Benefits
Does your complaint
Age
Race/Ethnicity
Sex (gender)
involve ("x" one or more):
Religion
Color
Gender Identity
Mental or Physical Disability
National Origin
Sexual Orientation
Describe the alleged discriminatory act (include dates, locations, names and contact information of witnesses - use one or
more additional pages, if necessary.)
Date signed
Signature of complainant (Person filing this complaint)
Do not write below this line.
The complaint is dismissed.
The following resolution is offered and the matter is concluded:
The above resolution has been offered but the matter is not concluded.
The complainant has been told about the federal and state agencies that are available if he or she wants to pursue the
matter further.
Additional comments:
By: (Director of Judicial Branch Human Resource Management Unit or designee)
Dated
Print Form
Reset Form