MCC Visit Request Form

This is a request for visit scheduling; it is NOT scheduled until you receive a confirmation email from the Visit Office that the visit has been scheduled.

Note: Contact visits are limited to three (3) visitors for all resident housing areas.  A resident may submit a Special Visit Request for additional seats.  These requests must be submitted to the Unit Team at least two weeks in advance and are reviewed on a case-by-case basis.  

 
Resident Name*:
Resident MDOC*:
Resident Housing Area*:
 

Click here for the MCC visit schedule

Click here for the SMWRC visit schedule
Visit Requested  
Day of Week*:
Date*:   MM/DD/YYYY
Time*:
Type of Visit Requested*:
   
Your Phone*:
Your Email*:
Confirm Email*:
   
Visitor 1 Name*:
Visitor 1 DOB*:
  A date of birth is required for all visitors.
Visitor 2 Name:
Visitor 2 DOB: MM/DD/YYYY
   
Visitor 3 Name:
Visitor 3 DOB:
   
Visitor 4 Name:
Visitor 4 DOB:
   
Visitor 5 Name:
Visitor 5 DOB: MM/DD/YYYY
   
Visitor 6 Name:
Visitor 6 DOB:
   
Message/Comment:
 

*All fields with an asterisk (*) are required*

Your visit is NOT scheduled until you receive a confirmation email from a staff member at the facility.