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Dear Applicant,

If you are considering applying to Merci’s Refuge, please first read our Program Overview. If you have questions about our program please contact Merci’s Refuge at 217-378-4045 or mercisrefuge@hopeforafuture.com.

If you believe Merci’s Refuge is a good fit for you at this time, please complete the online application below. Your application will remain confidential and will help us understand your current situation, and what you hope to accomplish in your life while at Merci’s Refuge and beyond. This will also help us determine if Merci’s Refuge is the right program to meet your goals and needs. If you have any questions or concerns while completing the application please contact us.

Application Checklist:

  • Read the Program Overview
  • Complete Merci’s Refuge Application online or request a paper copy. The entire application must be completed by the applicant.
  • We may require the following prior to intake at Merci’s Refuge:

1. A deoxification or substance abuse rehabilitation program depending on substance use history, current sobriety, and treatment history.
2. A physician’s or counselor’s statement that you are well enough to be in the program, or completion of medically advised treatments or surgeries.
3. Treatment summaries from past/present counseling/recovery programs.

  • Send all information to Merci’s refuge

Address: Merci’s Refuge, 209 E. Wilber Ave., Champaign, IL 61822
Fax: 217-398-0047 Email: mercisrefuge@hopeforafuture.com

  • Contact Merci’s Refuge to confirm your application and additional forms, if applicable, have been received.
  • Once we receive and review your application, Merci’s Refuge will contact you to schedule a telephone or in-person interview.
  • Once an interview is completed, our team will meet to make a decision regarding your application. Staff will then contact you with the outcome, as well as a date and time of your entry if accepted.

Application:

Merci’s Refuge Application

The information in this application is confidential and will not be held against you or used to judge you in any way. Merci’s Refuge is committed to helping women, and people who can become pregnant, in need of hope and healing. If for any reason we cannot meet your particular needs, we hope to refer you to someone who can. Please answer all questions honestly so we may know how to best help you. If a question does not apply to you, please write NONE or N/A next to it.

Merci’s Refuge is available to applicants between the ages of 18-40. If you are outside of that age range, please contact us so we can help connect with your other resources.