Grievance Complaint (Supreme Court Or Appellate Court) Filed Under The Americans With Disabilities Act {JD-ES-280}

GRIEVANCE COMPLAINT (SUPREME COURT OR APPELLATE COURT) FILED UNDER THE AMERICANS WITH DISABILITIES ACT JD-ES-280 New 5-11 STATE OF CONNECTICUT SUPERIOR COURT www.jud.ct.gov Instructions File this form with the Chief Administrative Officer, Supreme Court Building, 231 Capitol Avenue, Hartford, Connecticut 06106, (860) 757-2145, no later than ten (10) days after the act or decision complained about. Attach additional documents, if necessary. Name of person filing complaint Address (city) (state) (zip) E-mail (optional) Telephone Description of alleged discriminatory act or decision (include dates, locations, names and contact information of witnesses use additional page(s), if necessary.) Remedy or solution requested Signature of complainant (person filing this complaint) Date signed 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: Title: Date: The Judicial Branch of the State of Connecticut complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation in accordance with the ADA, contact a court clerk or an ADA contact person listed at www.jud.ct.gov/ADA/. Print Form Reset Form American LegalNet, Inc. www.FormsWorkFlow.com