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Disassociated-Persons-List-Application-Form 2026

The document is an application packet from the Michigan Gaming Control Board for individuals seeking to be placed on the Disassociated Persons List, which is designed for those who believe they are problem gamblers. It outlines the application process, required documents, and legal implications of being placed on the list, including restrictions on entering casinos and potential penalties for violations. The document emphasizes non-discrimination and accessibility for individuals with special needs.

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Click ‘Get Form’ to open the Disassociated Persons List Application Form in the editor.
Begin by filling out your personal information, including your full name, address, and contact details. Ensure accuracy as this information is crucial for identification.
Provide your social security number and date of birth. This data is necessary for verification purposes.
Complete the physical description section, detailing your height, weight, hair color, eye color, and any noticeable characteristics. This helps in proper identification.
Answer the series of yes/no questions regarding your understanding of the application process and your commitment to not visiting casinos. Each answer must be carefully considered.
Initial each page as required to confirm you have read and understood all instructions and conditions outlined in the application packet.
Do not sign the last page until your appointment at the Michigan Gaming Control Board office where it will be notarized.

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Who is the director of the Michigan Gaming Control Board?

The Executive Staff of the Michigan Gaming Control Board is composed of the Executive Director and four Deputy Directors. Henry Williams began his term as MGCB executive director on May 17, 2021. He was appointed by Governor Gretchen Whitmer on April 23, 2021.

Who regulates gaming in Michigan?

The Michigan Gaming Control Board (MGCB) regulates commercial casinos, horse racing, millionaire parties, internet gaming, internet sports betting, and fantasy sports. Other forms of legalized gaming include tribal casinos and lottery.

What is the Michigan Gaming Control and Revenue Act?

An act providing for the licensing and control of gambling operations, manufacturers and distributors of gaming devices and gaming employees; providing for the distribution of revenue for public education, public safety and economic development; authorizing limited operations within the State of Michigan;

What is the disassociated persons list?

The Disassociated Persons List (DPL) allows a person to voluntarily self-exclude from the Detroit commercial casinos for life, including Motor City , Hollywood at Greektown, and MGM Grand Detroit.

Who regulates gambling in Michigan?