Schedule Submission for Juvenile Community Corrections Monitored Supervision / Electronic Monitoring

Complete the form below in its entirety. Once you have completed all parts you may submit your schedule.

Note: you will receive a confirmation email with the details you entered. You will receive confirmation from Juvenile Community Corrections staff when your schedule is approved. Your schedule is not approved unless you receive this confirmation.

Schedules must be submitted no later than Thursday of each week for the next week.

Name *

Email Address *

Phone *

Please indicate which level(s) of monitoring you are on (select all that apply): *

Monitored Supervision Level 1Monitored Supervision Level 2Monitored Supervision Level 3Monitored Supervision Level 4Monitored Supervision Level 5Monitored Supervision Level 6Remote Breath Alcohol MonitoringProblem Solving Court

Do you need to enter a leave request for Sunday? *

YesNo

Date *

Purpose *

SchoolEmploymentProgrammingOther (enter below in text box)

If you selected other above, enter the purpose below. *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will enter your residence: *

Hours

Minutes

Do you need to add an additional leave request for Sunday? *

YesNo

Purpose *

SchoolEmploymentProgrammingOther (enter below in text box)

If you selected other above, enter the purpose below. *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will enter your residence: *

Hours

Minutes

Do you need to enter an additional leave request for Sunday? *

YesNo

Purpose *

SchoolEmploymentProgrammingOther (enter below in text box)

If you selected other above, enter the purpose below. *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will enter your residence: *

Hours

Minutes

Do you need to enter an additional leave request for Sunday? *

YesNo

Purpose *

SchoolEmploymentProgrammingOther (enter below in text box)

If you selected other above, enter the purpose below. *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will enter your residence: *

Hours

Minutes

Do you need to enter a leave request for Monday? *

YesNo

Date *

Purpose *

SchoolEmploymentProgrammingOther (enter below in text box)

If you selected other above, enter the purpose below. *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time will you will enter your residence: *

Hours

Minutes

Do you need to enter an additional leave request for Monday? *

YesNo

Purpose *

SchoolEmploymentProgrammingOther (enter below in text box)

If you selected other above, enter the purpose below. *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time will you will enter your residence: *

Hours

Minutes

Do you need to enter an additional leave request for Monday? *

YesNo

Purpose *

SchoolEmploymentProgrammingOther (enter below in text box)

If you selected other above, enter the purpose below. *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time will you will enter your residence: *

Hours

Minutes

Do you need to submit an additional leave request for Monday? *

YesNo

Purpose *

SchoolEmploymentProgrammingOther

If you selected other above, enter the purpose below *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will return to your residence: *

Hours

Minutes

Do you need to enter a leave request for Tuesday? *

YesNo

Date *

Purpose *

SchoolEmploymentProgrammingOther

If you selected other above, enter the purpose below *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will return to your residence: *

Hours

Minutes

Do you need to enter an additional leave request for Tuesday? *

YesNo

Purpose *

SchoolEmploymentProgrammingOther

If you selected other above, enter the purpose below *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will return to your residence: *

Hours

Minutes

Do you need to enter an additional leave request for Tuesday? *

YesNo

Purpose *

SchoolEmploymentProgrammingOther

If you selected other above, enter the purpose below *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will return to your residence: *

Hours

Minutes

Do you need to enter an additional leave request for Tuesday? *

YesNo

Purpose *

SchoolEmploymentProgrammingOther

If you selected other above, enter the purpose below *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will return to your residence: *

Hours

Minutes

Do you need to enter a leave request for Wednesday? *

YesNo

Date

Purpose *

SchoolEmploymentProgrammingOther

If you selected other above, enter the purpose below *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the time you will return to your residence: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will return to your residence: *

Hours

Minutes

Do you need to enter an additional leave request for Wednesday? *

YesNo

Purpose *

SchoolEmploymentProgrammingOther

If you selected other above, enter the purpose below *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will return to your residence: *

Hours

Minutes

Do you need to enter an additional leave request for Wednesday? *

YesNo

Purpose *

SchoolEmploymentProgrammingOther

If you selected other above, enter the purpose below *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will return to your residence: *

Hours

Minutes

Do you need to enter an additional leave request for Wednesday? *

YesNo

Purpose *

SchoolEmploymentProgrammingOther

If you selected other above, enter the purpose below *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will return to your residence: *

Hours

Minutes

Do you need to enter a leave request for Thursday? *

YesNo

Date *

Purpose *

SchoolEmploymentProgrammingOther

If you selected other above, enter the purpose below *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will return to your residence: *

Hours

Minutes

Do you need to enter an additional leave request for Thursday? *

YesNo

Purpose *

SchoolEmploymentProgrammingOther

If you selected other above, enter the purpose below *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will return to your residence: *

Hours

Minutes

Do you need to enter an additional leave request for Thursday? *

YesNo

Purpose *

SchoolEmploymentProgrammingOther

If you selected other above, enter the purpose below *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will return to your residence: *

Hours

Minutes

Do you need to enter an additional leave request for Thursday? *

YesNo

Purpose *

SchoolEmploymentProgrammingOther

If you selected other above, enter the purpose below *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will return to your residence: *

Hours

Minutes

Do you need to enter a leave request for Friday? *

YesNo

Date

Purpose *

SchoolEmploymentProgrammingOther

If you selected other above, enter the purpose below *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will return to your residence: *

Hours

Minutes

Do you need to enter an additional leave request for Friday? *

YesNo

Purpose *

SchoolEmploymentProgrammingOther

If you selected other above, enter the purpose below *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will return to your residence: *

Hours

Minutes

Do you need to enter an additional leave request for Friday? *

YesNo

Purpose *

SchoolEmploymentProgrammingOther

If you selected other above, enter the purpose below *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will return to your residence: *

Hours

Minutes

Do you need to enter an additional leave request for Friday? *

YesNo

Purpose *

SchoolEmploymentProgrammingOther

If you selected other above, enter the purpose below *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will return to your residence: *

Hours

Minutes

Do you need to enter a leave request for Saturday? *

YesNo

Date *

Purpose *

SchoolEmploymentProgrammingOther

If you selected other above, enter the purpose below *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will return to your residence: *

Hours

Minutes

Do you need to enter an additional leave request for Saturday? *

YesNo

Purpose *

SchoolEmploymentProgrammingOther

If you selected other above, enter the purpose below *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will return to your residence: *

Hours

Minutes

Do you need to enter an additional leave request for Saturday? *

YesNo

Purpose *

SchoolEmploymentProgrammingOther

If you selected other above, enter the purpose below *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will return to your residence: *

Hours

Minutes

Do you need to enter an additional leave request for Saturday? *

YesNo

Purpose *

SchoolEmploymentProgrammingOther

If you selected other above, enter the purpose below *

Street Address *

City *

ZIP / Postal Code *

Enter the time you will leave your residence: *

Hours

Minutes

Enter the start time of the event: *

Hours

Minutes

Enter the end time of the event: *

Hours

Minutes

Enter the time you will return to your residence: *

Hours

Minutes

Do you have verification of leave requests items to submit? (i.e. work schedules, receipts, medical notes, etc.) *

YesNoNote: You are required to submit verification of travel anytime outside of your home except for court ordered programming and school.

Verification of Leave Request: Use this space to submit photos of receipts from incentive time, medical notes for appointments, or other items that can verify your whereabouts.

Drag and Drop (or) Choose Files

Do you need to send a message to Monitored Supervision Staff? *

YesNo

If you selected yes to send a message to Community Corrections Staff, please type that message below. If this was done in error, please select no above.