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: Non-contact visits are limited to two (2) visitors for all resident housing areas. Contact visits are limited to three (3) COVID-19 vaccinated visitors for all resident housing areas. Proof of COVID-19 vaccination must be submitted to the Visit Office prior to requesting a contact visit.

 
Resident Name*:
Resident MDOC*:
Resident Housing Area*:
  Click here for 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*