Form DCF-2124 "Title IX: Initial Complaint Form" - Connecticut

What Is Form DCF-2124?

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 August 1, 2009;
  • 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-2124 by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Children and Families.

ADVERTISEMENT
ADVERTISEMENT

Download Form DCF-2124 "Title IX: Initial Complaint Form" - Connecticut

1182 times
Rate (4.8 / 5) 71 votes
Connecticut Department of Children and Families
TITLE IX: INITIAL COMPLAINT FORM
DCF-2124
8/09 (Rev.)
Page 1 of 1
Complainant Last Name:
Complainant First Name:
Telephone:
Address: (No. and Street):
City:
State:
Zip:
Today’s Date:
Date(s) of alleged incident(s):
Name(s) of person or persons you believe sexually harassed or discriminated against you:
List any witness name(s):
List Where the incident(s) occurred:
Describe the incident(s) as clearly as possible, including such things as: what force or physical contact, if any, was used, any verbal statements such as
threats, requests, demands, etc., what response(s) did you give; attach additional pages if more space is needed
SIGNATURES
This complaint was filed based on my honest belief that ________________________________________ has sexually harassed and/or discriminated
against me. I hereby verify that the information provided in this complaint is true, correct and complete, to the best of my knowledge and belief.
Complainant Signature
Date signed
Received by (Name / Title and Signature)
Date signed
Connecticut Department of Children and Families
TITLE IX: INITIAL COMPLAINT FORM
DCF-2124
8/09 (Rev.)
Page 1 of 1
Complainant Last Name:
Complainant First Name:
Telephone:
Address: (No. and Street):
City:
State:
Zip:
Today’s Date:
Date(s) of alleged incident(s):
Name(s) of person or persons you believe sexually harassed or discriminated against you:
List any witness name(s):
List Where the incident(s) occurred:
Describe the incident(s) as clearly as possible, including such things as: what force or physical contact, if any, was used, any verbal statements such as
threats, requests, demands, etc., what response(s) did you give; attach additional pages if more space is needed
SIGNATURES
This complaint was filed based on my honest belief that ________________________________________ has sexually harassed and/or discriminated
against me. I hereby verify that the information provided in this complaint is true, correct and complete, to the best of my knowledge and belief.
Complainant Signature
Date signed
Received by (Name / Title and Signature)
Date signed