Form DC6-111A at a glance
What it is: Form DC6-111A (Effective 03/23) is the Request for Visitation Privileges Application of the Florida Department of Corrections.
Who signs: Add your Signature, the Date and your Print Name (Last, First, Middle Name).
A filled-in Form DC6-111A example: a mother applies to visit her son
How to fill out Form DC6-111A, box by box
Inmate, DC# and your relationship
Enter the Inmate Name, the Inmate's Department of Correction Number (DC#) and Your Relationship to the Inmate (mother, friend, penpal,etc).
Mark No or Yes for Are You a Victim of this Inmate's Crime?
Complete Legal Name and Identifying Information
Under Complete Legal Name, enter the First name, Last name, Maiden name and Middle name.
Enter the Date of Birth, Age, Race and Sex under Identifying Information, and the Driver's License or State ID No. (16 yoa. and older) with its State and Number.
Complete Home Address and Phone Numbers
Under Complete Home Address, enter the Physical Address/Apt. #, City, County, State and Zip Code.
Under Phone Numbers, enter Home, Work and Cellular numbers, each with the area code.
Employment Status
Under Employment Status, enter the Place of Employment and mark No or Yes for Have you ever worked for the Florida Dept. of Corrections (employee, volunteer, contractor, vendor, etc.). List dates, location, and positions held.
Background
Mark No or Yes for Have you ever been arrested or received a criminal citation or a notice to appear in court to respond to criminal charges?
Mark No or Yes for Did you ever help this inmate commit a crime? Mark No or Yes for Were you ever in prison? Enter the Dates & Location of each imprisonment, the Prison # and what you were convicted of for each imprisonment.
Probation/Parole and the supervising agency
Mark No or Yes for Are you currently on Probation/Parole? If yes, circle one agency that is supervising you: State, Federal, County, Dept. of Juv. Justice or Other.
If Probation/Parole has been terminated, indicate date of termination. Say what you are on probation/parole for.
Enter the Name of Probation Officer and the Phone number of Probation Officer.
Other inmates, denied visits and where you met
Mark No or Yes for Are you approved to visit any other inmate? Enter their name(s) and DC#(s).
Mark No or Yes for Have your visitation privileges ever been denied, suspended, or terminated? Please explain.
Circle one for Where did you meet this inmate: Pen pal, Neighborhood, Work, Family, Prison or Other.
Certify, sign and submit, with a parent or guardian if under 18
You certify all the information above is complete, accurate, true and that you have read all of the Visitor Rules in Part 2 of this application and agree to follow these rules.
Giving false information is a second-degree misdemeanor and could result in the permanent suspension of your visitation privileges.
Criminal background checks will be made.
Add the Signature of Parent or Legal Guardian if under 18 years old, with the Date and Print Name (Last, First, Middle Name).
Submit this completed form by e-mail or U.S. Mail to the institution where you are requesting to visit.
More rules for Form DC6-111A
Persons 12 years old and older wanting to visit must complete this form.
Only one form per person.
Do not leave blanks, doing so will cause your application to be denied. When items do not apply, write in NA (not applicable).
Supplying false or misleading information results in your application being denied.
Continue on attached sheet if necessary for any item.
Be sure to sign the form in the space provided or it will not be processed.
Do not visit until the inmate notifies you of your approval.
Sources
[1] Form DC6-111A (Effective 03/23), Request for Visitation Privileges Application, Florida Department of Corrections (the Official source link on this page).
