Form JD-ES-263 "Grievance/Complaint Filed Under the Americans With Disabilities Act" - Connecticut

What Is Form JD-ES-263?

This is a legal form that was released by the Connecticut Superior Court - 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 August 1, 2020;
  • The latest edition provided by the Connecticut Superior Court;
  • 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-263 by clicking the link below or browse more documents and templates provided by the Connecticut Superior Court.

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Download Form JD-ES-263 "Grievance/Complaint Filed Under the Americans With Disabilities Act" - Connecticut

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GRIEVANCE/COMPLAINT FILED UNDER THE
STATE OF CONNECTICUT
AMERICANS WITH DISABILITIES ACT
SUPERIOR COURT
JD-ES-263 Rev. 8-20
www.jud.ct.gov
28 CFR § 35.107 (b)
Instructions
File this form with the Director, Human Resource Management Unit, 90 Washington Street,
For information on ADA accommodations,
Hartford, Connecticut 06106, (860) 706-5280, no later than ten (10) days after the alleged
contact a court clerk or go to:
discriminatory act or decision. Alternative means of filing a grievance/complaint, such as a
www.jud.ct.gov/ADA.
personal interview or a tape recording of the complaint, will be made available for a person
with a disability upon request. Attach additional documents or page(s), if necessary.
Name of person filing complaint
Telephone
E-mail (optional)
Address
Describe the alleged discriminatory act or decision:
(include dates, locations, names, and contact information of witnesses - use additional page(s), if necessary.)
What remedy or solution are you requesting?
Date signed
Signed (Signature of person filing this complaint)
FOR COURT USE ONLY
The complaint is dismissed.
The following resolution is offered:
The matter is concluded.
The matter is not concluded.
The complainant has been told about federal and state agencies that are available to pursue the matter further.
Additional Comments:
Director of the Human Resource Management Unit, or Director's Designee
Dated
Print Form
Reset Form
GRIEVANCE/COMPLAINT FILED UNDER THE
STATE OF CONNECTICUT
AMERICANS WITH DISABILITIES ACT
SUPERIOR COURT
JD-ES-263 Rev. 8-20
www.jud.ct.gov
28 CFR § 35.107 (b)
Instructions
File this form with the Director, Human Resource Management Unit, 90 Washington Street,
For information on ADA accommodations,
Hartford, Connecticut 06106, (860) 706-5280, no later than ten (10) days after the alleged
contact a court clerk or go to:
discriminatory act or decision. Alternative means of filing a grievance/complaint, such as a
www.jud.ct.gov/ADA.
personal interview or a tape recording of the complaint, will be made available for a person
with a disability upon request. Attach additional documents or page(s), if necessary.
Name of person filing complaint
Telephone
E-mail (optional)
Address
Describe the alleged discriminatory act or decision:
(include dates, locations, names, and contact information of witnesses - use additional page(s), if necessary.)
What remedy or solution are you requesting?
Date signed
Signed (Signature of person filing this complaint)
FOR COURT USE ONLY
The complaint is dismissed.
The following resolution is offered:
The matter is concluded.
The matter is not concluded.
The complainant has been told about federal and state agencies that are available to pursue the matter further.
Additional Comments:
Director of the Human Resource Management Unit, or Director's Designee
Dated
Print Form
Reset Form