Step 1 of 10 10% VAN PAP REGULARPermitted Activity RegularAmend Previously Submitted ActivitiesUrgent Medical ActivityYou are notifying 2 Watch of your medical activity. Must submit this form AND call our office at:564-888-2975Please take care of your medical situation. Hope all is well. Keep 2 Watch updates by calling 564-888-2975. Provide proof afterwards Name (as shown on ID or court order)* First Last Phone*Your Email* Court/Probation Permitted ActivityDate of the Activity MM slash DD slash YYYY Select the Permitted ActivityEmployment (if 'under the table' work, must be permitted by the court)Business Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify) Proof RequiredSelect the Permitted ActivityEmployment (if 'under the table' work, must be permitted by the court)Business Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify) Proof RequiredSelect the Permitted ActivityEmployment (if 'under the table' work, must be permitted by the court)Business Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther. Must explain and Proof RequiredOTHER please specify, when, where, duration. proof of approval*Address or General Location of Permitted Activity Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Time Activity Start : Hours Minutes AM PM AM/PM Time Activity End : Hours Minutes AM PM AM/PM Time Leave Home : Hours Minutes AM PM AM/PM Time Return Home : Hours Minutes AM PM AM/PM 1. Do you need to create another activity? Yes No Permitted ActivityDate of the Activity MM slash DD slash YYYY Select the Permitted ActivityWork (if under the table - must be court-approved). Proof RequiredBusiness Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify). Proof RequiredSelect the Permitted ActivityWork (if under the table - must be court-approved). Proof RequiredBusiness Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify). Proof RequiredSelect the Permitted ActivityWork (if under the table - must be court-approved). Proof RequiredBusiness Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify). Proof RequiredOTHER please specify, when, where, duration. proof of approvalAddress or General Location of Permitted Activity Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Time Activity Start : Hours Minutes AM PM AM/PM Time Activity End : Hours Minutes AM PM AM/PM Time Leave Home : Hours Minutes AM PM AM/PM Time Return Home : Hours Minutes AM PM AM/PM 2. Do you need to create another permitted activity? Yes No Date of the Activity MM slash DD slash YYYY Select the Permitted ActivityWork (if under the table - must be court-approved). Proof RequiredBusiness Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify). Proof RequiredSelect the Permitted ActivityWork (if under the table - must be court-approved). Proof RequiredBusiness Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify). Proof RequiredSelect the Permitted ActivityWork (if under the table - must be court-approved). Proof RequiredBusiness Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify). Proof RequiredOTHER please specify, when, where, duration. proof of approvalAddress or General Location of Permitted Activity Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Time Activity Start : Hours Minutes AM PM AM/PM Time Activity End : Hours Minutes AM PM AM/PM Time Leave Home : Hours Minutes AM PM AM/PM Time Return Home : Hours Minutes AM PM AM/PM 3. Do you need to create another activity? Yes No Date of the Activity MM slash DD slash YYYY Select the Permitted ActivityWork (if under the table - must be court-approved). Proof RequiredBusiness Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify). Proof RequiredSelect the Permitted ActivityWork (if under the table - must be court-approved). Proof RequiredBusiness Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify). Proof RequiredSelect the Permitted ActivityWork (if under the table - must be court-approved). Proof RequiredWork (if under the table - must be court-approved). Proof RequiredBusiness Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify). Proof RequiredOTHER please specify, when, where, duration. proof of approvalAddress or General Location of Permitted Activity Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Time Activity Start : Hours Minutes AM PM AM/PM Time Activity End : Hours Minutes AM PM AM/PM Time Leave Home : Hours Minutes AM PM AM/PM Time Return Home : Hours Minutes AM PM AM/PM 4. Do you need to create another activity? Yes No Date of the Activity MM slash DD slash YYYY Select the Permitted ActivityWork (if under the table - must be court-approved). Proof RequiredBusiness Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify). Proof RequiredSelect the Permitted ActivityWork (if under the table - must be court-approved). Proof RequiredBusiness Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify). Proof RequiredSelect the Permitted ActivityWork (if under the table - must be court-approved). Proof RequiredBusiness Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify). Proof RequiredOTHER please specify, when, where, duration. proof of approvalAddress or General Location of Permitted Activity Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Time Activity Start : Hours Minutes AM PM AM/PM Time Activity End : Hours Minutes AM PM AM/PM Time Leave Home : Hours Minutes AM PM AM/PM Time Return Home : Hours Minutes AM PM AM/PM 5. Do you need to create another activity? Yes No Date of the Activity MM slash DD slash YYYY Select the Permitted ActivityWork (if under the table - must be court-approved). Proof RequiredBusiness Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify). Proof RequiredSelect the Permitted ActivityWork (if under the table - must be court-approved). Proof RequiredBusiness Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify). Proof RequiredSelect the Permitted ActivityWork (if under the table - must be court-approved). Proof RequiredBusiness Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify). Proof RequiredOTHER please specify, when, where, duration. proof of approvalAddress or General Location of Permitted Activity Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Time Activity Start : Hours Minutes AM PM AM/PM Time Activity End : Hours Minutes AM PM AM/PM Time Leave Home : Hours Minutes AM PM AM/PM Time Return Home : Hours Minutes AM PM AM/PM 6. Do you need to create another activity? Yes No Date of the Activity MM slash DD slash YYYY Select the Permitted ActivityWork (if under the table - must be court-approved). Proof RequiredBusiness Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify). Proof RequiredSelect the Permitted ActivityWork (if under the table - must be court-approved). Proof RequiredBusiness Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify). Proof RequiredSelect the Permitted ActivityWork (if under the table - must be court-approved). Proof RequiredBusiness Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify). Proof RequiredOTHER please specify, when, where, duration. proof of approvalAddress or General Location of Permitted Activity Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Time Activity Start : Hours Minutes AM PM AM/PM Time Activity End : Hours Minutes AM PM AM/PM Time Leave Home : Hours Minutes AM PM AM/PM Time Return Home : Hours Minutes AM PM AM/PM 7. Do you need to create another activity? Yes No Date of the Activity MM slash DD slash YYYY Select the Permitted ActivityWork (if under the table - must be court-approved). Proof RequiredBusiness Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify). Proof RequiredSelect the Permitted ActivityWork (if under the table - must be court-approved). Proof RequiredBusiness Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify). Proof RequiredSelect the Permitted ActivityWork (if under the table - must be court-approved). Proof RequiredBusiness Owner and Licensed Operator. Proof RequiredTreatment, Counselling Self-help AA/NA. Proof RequiredCourt Appearance, Attorney, Probation. Proof RequiredGrocery 2hrs including drive time 1x weekly. Proof RequiredMedical Appointment. Proof RequiredReligious Activity per Court Order. Proof RequiredOn-Campus School. Proof RequiredOther (Must Specify). Proof RequiredOTHER please specify, when, where, duration. proof of approvalAddress or General Location of Permitted Activity Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Time Activity Start : Hours Minutes AM PM AM/PM Time Activity End : Hours Minutes AM PM AM/PM Time Leave Home : Hours Minutes AM PM AM/PM Time Return Home : Hours Minutes AM PM AM/PM I submit this activity request knowing that the activities and the times listed are compliant with the order of the court for my case. Validation of this request is incumbent upon me to disclose and provide copies of documents, receipts, payroll time sheets, confirmation of medical appointments for all court-authorized activities. I understand that failure to provide this information when requested will result in program violation and possible removal. All court appearances and court-authorized activities must be scheduled. Report to 2WM office after court unless in custody. Signature*Today's Date* MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.
