Mdoc Visiting Application Form PDF Details

Planning a visit to a loved one in a Michigan correctional facility introduces individuals to the M.D.O.C. Visiting Application (CAJ-103), a form designed to streamline the process while ensuring the safety and security of both visitors and inmates. Detailed instructions guide applicants through filling out Sections A through E, emphasizing the importance of completeness and legibility to avoid delays. Applicants must disclose personal information, relationship to the inmate, and any past or present criminal convictions, with specific attention to any incarceration history or restrictions from visiting prisons. The form uniquely addresses minors, requiring additional verification and the accompaniment of an adult family member or legal guardian during visits. Mailing instructions remind users to include a self-addressed stamped envelope for notification purposes, underlining the fact that approval notifications are only sent out if this envelope is provided, while denials are communicated regardless. By meticulously following these instructions and providing accurate, honest information, applicants pave the way for a smooth visitation process, reinforcing the system's commitment to maintaining a secure, welcoming environment for family connections to flourish within the bounds of the law.

QuestionAnswer
Form NameMdoc Visiting Application Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesmichigan prison visit, application for visitation, michigan prison visitation, form mdoc

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M.D.O.C. VISITING APPLICATION

CAJ-103 ■ REV. 06/11 ■ 4835-0103

Instructions For Visitors Filling Out This Application

This is an application to visit a prisoner in a Michigan correctional facility. All questions in section A and B must be answered. If a question does not apply, write Not Applicable on the line. ALL questions in Section C must be checked YES or NO. If you check YES, you must supply the requested information. All entries on this form must be clearly printed and legible. This form must be legibly signed and dated as indicated in Section D. Forms that are not legible will not be processed. Section E must be completed if applicant is a minor. Do not complete Section F. Mail the completed application to the mail room or deliver to the information desk of the facility you are requesting to visit. Do not mail the application to the prisoner. Including a self-addressed-stamped envelope when this application is returned will ensure that you receive notification of your approval or denial to visit. Without a self-addressed-stamped envelope, you will be notified only if your application is denied.

YOUR DRIVER LICENSE #

/

 

OR State ID #

/

 

 

(State)

 

(Number)

 

(State)

 

(Number)

Your Full Name (Please print)

(Last)

(First)

 

(Middle)

Your Address

 

 

 

 

 

 

 

 

 

(Street)

 

 

(Apt. #)

 

 

 

 

 

 

 

 

(City)

 

 

(State)

 

 

(Zip)

Your Date and Place of Birth

/

 

 

/

 

(City)

 

 

 

 

 

 

 

 

 

(Mo./Day/Yr.)

 

 

 

 

 

 

 

 

 

 

Prisoner Name

 

 

A

 

 

 

 

 

 

 

 

(Last)

(First)

(Middle)

 

 

Prisoner Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(State)

List ALL other names you have used (including aliases, maiden name, and names by previous marriages)

 

CHECK ONE

(Last)

 

(First)

 

(Middle)

 

MALE

(Last)

 

(First)

 

(Middle)

 

 

 

 

FEMALE

(Last)

 

(First)

 

(Middle)

 

 

 

 

 

Your relationship to the prisoner

(Are you the parent, grandparent, stepparent, spouse, child, sibling, father/mother-in-law, stepchild, grandchild, stepbrother/sister, etc.)

B

Are you a MDOC employee or provide contractual services to the MDOC?

YES

NO Work location

 

 

 

 

Are you a prisoner or a former prisoner who was incarcerated in a state or federal prison in any jurisdiction?

 

YES

NO

If so, what city & state

 

 

 

 

 

 

 

 

Date

 

 

Ever been restricted from visiting a prisoner?

YES

NO

Prisoner name & number

 

 

 

 

Date & reason for restriction

 

 

 

 

 

 

 

 

 

 

 

 

Are you currently on Parole / Probation for a felony?

YES

NO

What city & state

 

 

 

 

Have you ever been convicted of a FELONY?

YES

NO

When (mo. /yr.)

 

 

City & state

 

 

 

 

Conviction

 

 

 

 

(List all convictions • use additional paper if necessary)

C

 

I SUBMIT THAT ALL OF THE INFORMATION IS TRUE

 

 

 

 

 

 

 

 

 

 

 

 

 

D

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE OF VISITOR APPLICANT

 

 

 

DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TO BE COMPLETED IF VISITOR IS A MINOR (unless emancipated)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I submit that above named minor is a child, stepchild, grandchild, sibling, half-sibling, or step-sibling of this prisoner. I also understand that all children

E

 

 

must be accompanied by an adult immediate family member or a legal guardian of the child.

 

 

 

 

 

 

 

 

 

 

I SUBMIT THAT ALL OF THE INFORMATION IS TRUE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE OF THIS CHILD’S NON-INCARCERATED PARENT OR LEGAL GUARDIAN

 

 

 

NOTE: A COPY of the minor’s birth certificate, certificate of adoption or court order establishing paternity must be submitted with this application.

 

 

 

These copies of documents will not be returned but will be destroyed when the verification process is complete. An original or a certified true copy

 

 

 

of birth certificate, certificate of adoption, a court order establishing paternity or a valid picture ID of the minor must be presented at each visit.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STAFF USE ONLY (Type or Print Legibly)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Self-addressed-stamped envelope included?

 

Yes

No

 

 

 

 

 

Facility MDOC Visiting Application processed at

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

On Visitor List

PSI reviewed

LEIN completed

 

 

Application complete

Date received

 

 

 

 

 

 

 

 

 

 

Checks completed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

Signature of Reviewer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Application

APPROVED

 

DENIED

Approved / Denied by

 

 

 

Date

 

 

 

 

 

F

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Warden’s Signature (if applicant is a prisoner, former prisoner or is on parole or probation)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reason for denial

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other comments

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If you have been denied access to a corrections facility because of criminal history information obtained from the LEIN network,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

You may inquire about outstanding warrants by appearing at a police department and presenting identification.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

You may obtain a copy of your Michigan criminal history record at www.michigan.gov/ichat. There is a fee for this service.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Entered in Visitor Tracking

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Initials)

 

 

 

 

 

 

 

 

 

 

(Date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTE: If form copied from the MDOC website, duplication and distribution by reviewing facility is required after the approval process is complete.

Distribution:

Institution Record Office File

Counselor File

Information Desk

Visitor

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Tips to prepare michigan department of corrections visitor application step 1

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