Connecticut Furlough Request to the Commissioner of Correction
Connecticut Furlough Request to the Commissioner of Correction
To: Commissioner of Correction
Through: [WARDEN / FACILITY CONTACT, IF REQUIRED]
From: [INMATE NAME OR AUTHORIZED COUNSEL]
Date: [__/__/____]
Re: Request for furlough under Conn. Gen. Stat. § 18-101a
1. Inmate and Facility
| Item | Information |
|---|---|
| Inmate's full legal name | [________________________________] |
| DOC number | [________________________________] |
| Current facility | [________________________________] |
| Counsel or other contact, if any | [________________________________] |
| Return address and telephone | [________________________________] |
2. Request and Statutory Purpose
I request that the Commissioner of Correction consider a furlough under Conn. Gen. Stat. § 18-101a. I understand that the Commissioner decides whether to authorize a furlough and may set its conditions. This request is for the following statutory purpose (check one or explain a combination):
- ☐ Visit a dying relative: [NAME, RELATIONSHIP, AND LOCATION]
- ☐ Attend a relative's funeral: [NAME, RELATIONSHIP, DATE, AND LOCATION]
- ☐ Obtain medical services not otherwise available: [PROVIDER, SERVICE, AND LOCATION]
- ☐ Contact a prospective employer: [EMPLOYER, CONTACT, AND LOCATION]
- ☐ Another compelling reason consistent with rehabilitation: [EXPLAIN]
Facts supporting the request: [DESCRIBE THE NEED, TIMING, AND RELEVANT CIRCUMSTANCES]
[____________________________________________________________]
[____________________________________________________________]
3. Proposed Itinerary
| Item | Proposed detail |
|---|---|
| Requested departure | [DATE AND TIME] |
| Requested return | [DATE AND TIME] |
| Place or places to be visited | [SPECIFIC ADDRESSES] |
| Transportation and responsible person | [________________________________] |
| Lodging or sponsor, if any | [NAME, ADDRESS, PHONE] |
| Contact number during furlough | [________________________________] |
The requested period is [NUMBER] day(s), within the statutory limit of 45 days per authorized period. Section 18-101a leaves any renewal to the Commissioner's discretion. I will comply with the conditions imposed by DOC and return as directed in any furlough agreement.
4. Supporting Information
The following information may assist DOC in assessing whether I will honor the trust placed in me and whether the proposed visit can be carried out safely:
- Institutional conduct and program participation: [________________________________]
- Proposed supervision or check-in arrangements: [________________________________]
- Sponsor or contact willing to confirm the itinerary: [________________________________]
- Any additional facts for DOC's review: [________________________________]
Attached documents:
- ☐ Medical statement or appointment confirmation
- ☐ Funeral notice or family statement
- ☐ Employer interview or contact confirmation
- ☐ Proposed travel plan and sponsor contact information
- ☐ Other: [________________________________]
5. Requested Decision
Please review this request and notify me or my counsel of the decision and any conditions or documents DOC requires. I understand that § 18-101a grants furlough authority to the Commissioner of Correction, and that failing to return as provided in a furlough agreement is treated as escape in the first degree under that section.
Respectfully submitted,
Signature: [________________________________]
Printed name: [________________________________]
Capacity: ☐ Inmate ☐ Authorized counsel
Date: [__/__/____]
Counsel's Connecticut bar number, if applicable: [________________________________]
Submission note: Give this request to the facility or DOC contact designated for furlough applications. Confirm the current DOC procedure and any required agency form before submission. This document does not request a Superior Court order.
About this template
- Last updated
- October 23, 2026
- Citations checked
- October 16, 2026
- Jurisdiction
- Connecticut
- Category
- Criminal Law
Legal authority
- Conn. Gen. Stat. § 18-101a (Furlough Programs)
Criminal law paperwork covers every stage of a criminal case, from the first appearance and bail motion through pretrial motions, plea agreements, sentencing, and appeals. Deadlines in criminal cases are short and often unforgiving, and constitutional rights can be waived just by missing a filing. Using the right motion at the right time can mean the difference between evidence getting suppressed, charges getting reduced, or a case getting dismissed entirely.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
A reviewer verified this template's legal citations against the official source on October 16, 2026.
Conn. Gen. Stat. § 18-101a (checked October 16, 2026): "The Commissioner of Correction, at the commissioner's discretion, may extend the limits of the place of confinement of an inmate as to whom there is reasonable belief he or she will honor his or her trust, by authorizing the inmate under prescribed conditions to visit a specifically designated place or places, within or without the state, for periods not exceeding forty-five days and return to the same or another institution or facility."
Conn. Gen. Stat. § 18-101a (permitted purposes) (checked October 16, 2026): "Such furlough may be granted only to permit a visit to a dying relative, attendance at the funeral of a relative, the obtaining of medical services not otherwise available, the contacting of prospective employers or for any compelling reason consistent with rehabilitation."
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