Virginia Department of Corrections — Public Safety First

Adult Visitor Application and Background Investigation Authorization

By completing this request and authorization, I acknowledge that visitation of offenders at this VADOC facility is a privilege. This privilege may be revoked or suspended for violation of rules, overcrowding, or as a result of suspicious behavior. A visiting brochure is available upon request.

Visitor Information
Check Box if Emancipated Minor
Visitor's Legal First Name
Visitor's Legal Middle Name
Visitor's Legal Last Name
Visitor's Maiden Name
Visitor's Alias Name
ID Number
SSN (last 4)
Race
Ethnic Origin
Sex
Hair Color
Eye Color
Height	Ft. In.
Weight	Lbs.
Date of Birth
Place of Birth (City/County, State, and Country)

Your Current Mailing Address
Street Address/PO Box
State
If you reside in the state of Virginia, please select a city or town from the following dropdown list. Virginia Resident: City/Town/Other Principal Subdivision
If you reside outside of the state of Virginia, please enter your city or town in the free form field following the drop down list. Non-Virginia Resident: City/Town/Other Principal Subdivision
Postal Code (ZIP)
Country
E-mail Address
Phone Number

Information on Offender You Want to Visit
Offender's Incarcerated Name (First and Last)	Offender Locator
Offender's Incarcerated Number
Offender's Facility
Your relationship to Offender	FamilyFriend
To add minor visitors for this offender, click the Add Minor Visitor button.
To add multiple offenders, enter offender information and click Save Offender.

Vehicle Information
Own a vehicle?	YesNo
Make
Model
Year
Plate Number

Conditions
YesNo	Have you been convicted of a felony in any jurisdiction?
YesNo	Have you ever been employed by, volunteered with, or contracted by the Virginia Department of Corrections or Virginia Department of Correctional Education?
YesNo	Are you currently under active parole or probation supervision?
	P&P District: DOC ID Number:
YesNo	Are you a victim or family of a victim of the current crime committed by the offender with whom you wish to visit?
YesNo	Are you now or have you ever been a member or associated with any gang, motorcycle club, racial supremacy group, or other such group or organization as defined in Code of Virginia §18.2-46.1?

Please type "visitor"

I authorize the Department of Corrections to conduct a criminal records check, or to use any Department of Corrections records to verify accuracy of information provided on this form.

The above information is true and correct. I understand that providing false information on this form is grounds for denying visiting privileges. By clicking the Submit button, I agree that I have read and understand the above statements.