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Fill a Valid Iowa Visitor Application Template

The Iowa Visitor Application form is a document required for individuals wishing to visit someone incarcerated within the Iowa Department of Corrections. This form collects essential information about the visitor and their relationship to the incarcerated individual, ensuring compliance with state regulations. It is important to complete the application accurately to avoid denial of visiting privileges.

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Contents

The Iowa Visitor Application form is a crucial document for anyone wishing to visit an incarcerated individual within the Iowa Department of Corrections. This form requires detailed personal information from the visitor, including their legal name, contact information, and relationship to the incarcerated person. It's essential to provide accurate information, as any discrepancies or omissions can lead to denial of the application. Visitors must also disclose any past legal issues, including arrests or incarceration, to ensure a thorough background check. The form emphasizes the importance of safety, requiring visitors to confirm their legal citizenship and to provide identification upon arrival. Additionally, it includes specific guidelines regarding the visitation of minors and the responsibilities of guardians. Understanding these requirements is vital, as the approval process hinges on the completeness and truthfulness of the submitted information. Visitors should not attempt to visit until they receive notification of approval from the incarcerated individual, highlighting the need for patience and adherence to the process. Furthermore, the form outlines potential consequences for violations, including search procedures and drug testing protocols, underscoring the seriousness of maintaining security within correctional facilities.

Iowa Visitor Application Preview

Confidential	IOWA DEPARTMENT OF CORRECTIONS
Information Not	Visitor Application
Public Record	(one adult applicant per questionnaire)

PLEASE DO NOT ATTEMPT TO VISIT UNTIL THE INCARCERATED INDIVIDUAL NOTIFIES YOU OF

YOUR APPROVAL.

NOTICE: Before completing this application, please review the Department of Corrections search procedures on the back of this application. DO NOT LEAVE BLANKS OR PROVIDE FALSE INFORMATION. Doing so will cause your application to be DENIED.

1.	Incarcerated individual name:					Incarcerated individual number:
VISITOR INFORMATION
2.
	Legal Last name	Legal First name		Middle	Maiden name		Phone number
3.	Your relationship to incarcerated individual:				How long have you known the incarcerated individual?
4.
	Birth date	Sex	Marital status		Spouse’s Name		Your Social Security number
5.
	Address			City		County	State	Zip code

6.Please list only YOUR children or children you have guardianship of (please provide proof) under age 18 who will be visiting with you. Anyone over age 18 must complete a separate questionnaire.

Name

Date of birth

SS#

M –

SS#

M –

Relationship to incarcerated individual

Name

Date of birth

SS#

M –

SS#

M –

Relationship to incarcerated individual

In regards to the incarcerated individual’s children, the parent/guardian must complete the application and check one of the following:

Children can only visit with the approved parent/guardian Children can visit with any approved adult visitor

7. Do you have any pending charges?		Yes	No
Where			If yes, what is the charge(s)

8.If you have been arrested as either an adult or juvenile, complete all information below. Include all misdemeanors and felonies, deferred judgments, and any periods of incarceration including jail time.

9.	Are you now or have you ever been incarcerated or on probation/parole?			Yes	No
	Where	Discharge Date:
10.	Have you ever been involved in the illegal use of drugs?	Yes	No

11. Are you currently, or have you ever been, a Department of Corrections employee or volunteer, a contractor, or private

sector employer working for the Department of Corrections? Yes No If yes, please list the name of the institution and dates of employment or volunteer work:

Date(s):

12.Have you previously been or are you presently on the visiting list of any incarcerated individual in the Department of Corrections?

Yes No

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OP-MTV-04 F-1

13. Have your visitation privileges ever been denied, suspended, or terminated?

Yes

14.If you answered “yes” to either of the two above questions, please list incarcerated individual’s name, number and your relationship to him/her:

15.To enhance your safety as a visitor, please let us know if you have been the victim of an incarcerated individual supervised/incarcerated by the IDOC. If so, please list the incarcerated individual (s) name, ID number (if known), county, charge and case number:

16. Are you a legal citizen of the United States (you will be required to show a picture ID to visit).

Yes

NOTICE: The Department of Corrections will evaluate this information against state and federal law enforcement databases. Failure to accurately complete any of the above information will result in rejection of this application. Please ensure that you sign the back page of the application. You are advised to keep a copy of this application

NOTICE:

All visitors are subject to search procedures: This may include non-intrusive electronic search methods. If a visitor refuses to be searched, you will not be permitted to visit and your visiting privileges may be revised.

In order to maintain drug-free prison zones, the non-intrusive ION SCAN method of detecting the use of, handling of or association with illegal substances (drugs) may be applied to prospective visitors. Should this test provide a positive indication of illegal substance association or you refuse to be tested, the following minimum visiting restrictions shall apply:

A)First Occurrence. Visiting privileges will be suspended from the date and time of the test for the next two (2) visiting days. Future visits may be restricted to non-contact status.

B)Second Occurrence. Visiting privileges will be suspended from the date and time of the test for the next seven (7) visiting days. Future visits may be restricted to non-contact status.

C)Third Occurrence. Visiting privileges will be suspended from the date and time of the test for the next fifteen (15) visiting days. Future visits may be restricted to non-contact status.

D)Fourth Occurrence. Visiting privileges will be suspended from the date and time of the test for the next thirty (30) visiting days. In addition, you will be placed on non-contact visit status for one hundred and eighty (180) days from the date of the first eligible visit. If you test positive from this date forward, visiting privileges may be permanently restricted to non-contact status.

E)Refusal to submit to being tested will suspend visiting privileges to the facility for fifteen (15) calendar days from the time of refusal.

Visitors may send a written appeal to the Warden regarding receipt of any of the above sanctions.

I hereby give my consent to initiate a background investigation with law enforcement agencies and authorize law enforcement agencies to furnish information. I also understand any falsification of the information I provided above will disqualify me from visiting.

17.

Signature

Date

It is the responsibility of the incarcerated individual to notify you of visitor application approval.

Return completed application to Centralized Visiting Authority to:	Mt. Pleasant Correctional Facility
	Attn: Central Records
	1200 E. Washington
cc: file	Mt. Pleasant, IA 52641
cc: file

BREAK THE SILENCE -- Iowa DOC has a zero tolerance for sexual violence of any kind. If you are told about or are concerned about sexual violence committed against any person in an IDOC prison, please contact the Warden immediately.

Revised: Oct. 2000, Sept. 2006, June 2007, Feb. 2008. Reviewed: Feb. 2009. Revised: July 2010. Reviewed: Jan. 2011, May

2012. Revised: Nov. 2013, Oct. 2014, July 2015, April 2016. Reviewed: April 2017. Revised: April 2019. Page 2 of 2

OP-MTV-04 F-1

⇓ PDF File

Document Attributes

Fact Name	Details
Confidentiality	The Iowa Visitor Application form is confidential and not considered a public record.
Approval Requirement	Visitors must wait for notification of approval from the incarcerated individual before attempting to visit.
Application Completeness	Incomplete applications or false information will lead to denial of the application.
Children's Visitations	Only children under 18 who are the applicant's own or for whom they have guardianship can visit, requiring proof.
Background Check	Information provided will be evaluated against state and federal law enforcement databases.
Search Procedures	All visitors are subject to search procedures, including non-intrusive electronic methods.
Legal Compliance	The application process is governed by Iowa Code Chapter 904, which outlines the Department of Corrections' regulations.

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