Visiting Application Adult

Resident’s Name: IDOC Number: Institution:
Applications must be renewed yearly. Is this a renewal application?  Yes  No
Read carefully. Your complete name is mandatory. Answer all questions. If a question does not apply, write ‘NA’. If you do not know the answer, explain as best you can. Use additional
paper if necessary.
1. Your Name:
(Last) (First) (Middle)
2. Other Names Used:
3. Date of Birth: SSN:
(mm/dd/yyyy)
4. Place of Birth: City: State:
5. Gender:  Male  Female
6. Driver’s License/State ID number: State issued:
7. Eye Color: Hair color: Weight: Height: Race:
8. Present Street Address:

(City) (State (Zip)
9. Telephone Number: All Other States Lived In:
10. What is your relationship to the resident?
(Mother, father, spouse, girlfriend/boyfriend, son, daughter, etc. Only list ‘spouse’ if legally married.)
11. How long have you known the resident and how did you meet?
12. Have you visited another resident within the last year?  Yes  No
13. What are the other resident's name and your relationship with the resident?
14. Do you currently visit another resident?  Yes  No
Resident's Name: IDOC Number:
What is your relationship with the resident?
15. Have you ever been employed by the Idaho Department of Correction (IDOC)?  Yes  No
16. Have you ever been a volunteer for IDOC?  Yes  No
17. Have you ever been a contractor, vendor, or intern for IDOC?  Yes  No
If yes, give dates and locations:
18. Are you on probation or parole?  Yes  No
If yes, where:
What is your probation and parole officer’s name?
19. Have you ever been a victim of a crime?  Yes  No
If yes, crime: When:
Name of the resident:
20. Your employer: Telephone number:
21. Employer’s address:
22. Do you have any pending criminal charges?  Yes  No
Charge:
I understand that missing or false information may delay or result in a denial of my application. I have read and agree to follow the IDOC’s visiting rules.
________________________________________________ _______________________
Signature of Applicant (If 18 years of age or older) Date
Note: If the applicant is under 18 years of age, the parent or guardian accompanying the child on the visit must also submit the following: Visiting Application (Minor Child), and a
certified copy of the child’s birth certificate. In addition, Guardians must also submit a copy of the court order granting legal guardianship (or Power of Attorney Delegating Limited
Powers for Visitation).
Staff Use Only

Background Check:
Criminal record: 
No criminal record: 
Comments:____________________
Approval Authority:
Approved:  Denied: 
Date: ________________
Staff: _______________________
Associate #: __________
Appellate Authority:
Approved: 
Denied: 
Date: ________________