Form DCF-0065 "Conditions of Parole" - Connecticut

What Is Form DCF-0065?

This is a legal form that was released by the Connecticut State Department of Children and Families - 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 September 1, 2008;
  • The latest edition provided by the Connecticut State Department of Children and Families;
  • 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 DCF-0065 by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Children and Families.

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Download Form DCF-0065 "Conditions of Parole" - Connecticut

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Department of Children and Families
CONDITIONS OF PAROLE
DCF-0065
9/08 (Rev.)
Date:
Name of Child/Youth
DOB:
Date of Home Placement
End of Commitment Date:
The Commissioner of Children and Families, or his/her designee, having reviewed and considered your case, has decided to place you on
Parole Status at:
Address of Home Placement:
City:
State:
Zip:
Parole Status is granted to you subject to the conditions set forth in Connecticut General Statutes §17a-7 and §17a-8, with the clear
understanding that should you violate any condition of your Parole, the Commissioner or his/her designee may revoke your Parole Status and
place you at any institution, resource, or facility administered by or available to the Department of Children and Families, including, for boys,
Connecticut Juvenile Training School in Middletown, Connecticut.. Whenever problems arise or you do not understand what is expected of
you on Parole Status, it is your responsibility to consult your:
at
Parole Officer Name
Phone Number
He or she will assist you and explain your Conditions of Parole.
If at any time you believe your placement is not meeting your treatment needs, you may request a Treatment Plan Hearing, by writing to
the Commissioner of DCF., specifically stating the elements of your treatment plan with which you are not in agreement. You may ask your
lawyer or parent to help you do this, or you may write the letter yourself. You are encouraged to speak with your Parole Officer and to
request a Treatment Plan Hearing rather than leave your placement without permission. If you do leave your placement without permission,
you will be in violation of your Parole and face the possibility of admission to a secure or non-secure facility.
REMEMBER, at any time you may contact your Parole Officer to discuss problems with your placement or treatment plan, especially issues
that may influence you to leave your placement without permission.
NOTE: Connecticut law permits the Department to revoke your Parole status whenever revocation is determined to be in your best
interests. Therefore, it is possible, although unlikely, that your Parole status will be revoked even if you have not violated a specific Condition
of Parole.
CONDITIONS OF YOUR PAROLE ARE AS FOLLOWS:
1.
You must obey the rules and requirements of the above-named placement.
2.
You must not leave the above-named placement without first obtaining permission from your Parole Officer. When you are eligible
for passes, arrangements, including visit address and phone number, must be verified and approved by your Parole Officer before
each pass is issued. Out-of-state visits require that one week prior notice be given to your Parole Officer. The Department reserves
the right to restrict passes on certain holidays or during specific events.
3.
You must not own, possess, use, sell, or have under your control any dangerous weapon or firearm.
4.
You must not use, or have in your possession or control, any illegal drug or narcotic (marijuana, crack, cocaine, heroin, acid,
barbiturates, etc.)
5.
You must not possess or consume alcoholic beverages, or any form of intoxicant, or abuse legal or illegal substances.
6.
You must comply with random drug screening by Parole Services or its designee.
7.
You must attend school regularly and attend all classes. If you are not in school due to suspension or other educational issues, your
Parole Officer must be notified. If you are not in school because of age, you must seek full-time employment.
8.
You must obey all state and local laws. If you are arrested for ANY reason, you are required to immediately report the nature of the
incident and offense(s) by contacting your Parole Officer or Connecticut Juvenile Training School at 860-638-2400 or after 4:45 p.m.
at 1-860-638-2897. If placed in detention or jail, you must inform detention or correctional officials that you are a DCF committed
delinquent on Parole.
9.
You must not affiliate yourself with any street gang or associate with individuals engaged in illegal activity.
10. You must also comply with the following special conditions:
a.
Maintain weekly contact with Parole Officer.
b.
Participate in the following scheduled programs:
i.
ii.
iii.
iv.
Department of Children and Families
CONDITIONS OF PAROLE
DCF-0065
9/08 (Rev.)
Date:
Name of Child/Youth
DOB:
Date of Home Placement
End of Commitment Date:
The Commissioner of Children and Families, or his/her designee, having reviewed and considered your case, has decided to place you on
Parole Status at:
Address of Home Placement:
City:
State:
Zip:
Parole Status is granted to you subject to the conditions set forth in Connecticut General Statutes §17a-7 and §17a-8, with the clear
understanding that should you violate any condition of your Parole, the Commissioner or his/her designee may revoke your Parole Status and
place you at any institution, resource, or facility administered by or available to the Department of Children and Families, including, for boys,
Connecticut Juvenile Training School in Middletown, Connecticut.. Whenever problems arise or you do not understand what is expected of
you on Parole Status, it is your responsibility to consult your:
at
Parole Officer Name
Phone Number
He or she will assist you and explain your Conditions of Parole.
If at any time you believe your placement is not meeting your treatment needs, you may request a Treatment Plan Hearing, by writing to
the Commissioner of DCF., specifically stating the elements of your treatment plan with which you are not in agreement. You may ask your
lawyer or parent to help you do this, or you may write the letter yourself. You are encouraged to speak with your Parole Officer and to
request a Treatment Plan Hearing rather than leave your placement without permission. If you do leave your placement without permission,
you will be in violation of your Parole and face the possibility of admission to a secure or non-secure facility.
REMEMBER, at any time you may contact your Parole Officer to discuss problems with your placement or treatment plan, especially issues
that may influence you to leave your placement without permission.
NOTE: Connecticut law permits the Department to revoke your Parole status whenever revocation is determined to be in your best
interests. Therefore, it is possible, although unlikely, that your Parole status will be revoked even if you have not violated a specific Condition
of Parole.
CONDITIONS OF YOUR PAROLE ARE AS FOLLOWS:
1.
You must obey the rules and requirements of the above-named placement.
2.
You must not leave the above-named placement without first obtaining permission from your Parole Officer. When you are eligible
for passes, arrangements, including visit address and phone number, must be verified and approved by your Parole Officer before
each pass is issued. Out-of-state visits require that one week prior notice be given to your Parole Officer. The Department reserves
the right to restrict passes on certain holidays or during specific events.
3.
You must not own, possess, use, sell, or have under your control any dangerous weapon or firearm.
4.
You must not use, or have in your possession or control, any illegal drug or narcotic (marijuana, crack, cocaine, heroin, acid,
barbiturates, etc.)
5.
You must not possess or consume alcoholic beverages, or any form of intoxicant, or abuse legal or illegal substances.
6.
You must comply with random drug screening by Parole Services or its designee.
7.
You must attend school regularly and attend all classes. If you are not in school due to suspension or other educational issues, your
Parole Officer must be notified. If you are not in school because of age, you must seek full-time employment.
8.
You must obey all state and local laws. If you are arrested for ANY reason, you are required to immediately report the nature of the
incident and offense(s) by contacting your Parole Officer or Connecticut Juvenile Training School at 860-638-2400 or after 4:45 p.m.
at 1-860-638-2897. If placed in detention or jail, you must inform detention or correctional officials that you are a DCF committed
delinquent on Parole.
9.
You must not affiliate yourself with any street gang or associate with individuals engaged in illegal activity.
10. You must also comply with the following special conditions:
a.
Maintain weekly contact with Parole Officer.
b.
Participate in the following scheduled programs:
i.
ii.
iii.
iv.
ACKNOWLEDGMENT
I have read, or have had read to me, the above noted conditions of my Parole. I fully understand them and agree to strictly follow them.
I understand that should I violate any of the previously noted Conditions of Parole, I could be admitted to any institution, resource, or
facility administered by or available to the Department of Children and Families, including, for boys, Connecticut Juvenile Training School,
and my parole status may be revoked.
In the event that I am admitted to Connecticut Juvenile Training School or any other institution, resource, or facility administered by or
available to the Department of Children and Families because of an alleged violation of the above Conditions of Parole, I will be given
written notice of the reason(s) for my placement and shall have the right to a hearing.
I also understand that even in the absence of a violation of a parole condition, I could be returned to any institution, resource, or facility
of the Department of Children and Families if, in the opinion of the Commissioner or his/her designee, it is no longer in my best interest
to remain in placement or on Parole Status.
Name of Youth/Parolee
Signature of Youth / Parolee
Date
Name of Witness
Signature of Witness
Date
Distribution:
Copy to Parolee
Copy to Parole Officer
Copy to Parolee’s Parent(s) or Guardian
Copy to Parolee’s Case Record
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