Merci's Refuge Services Application| Pregnancy Resource Center

Merci’s Refuge Application

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Dear Applicant,

If you are considering applying to Merci’s Refuge then you should have already read about our Program Overview and Resident Handbook.  If you have not received that information or spoken with a representative from Merci’s Refuge please call 217-378-4045 to request more information first.

Once you are confident Merci’s Refuge is the right program for you at this time then please continue our assessment process by completing the online application at the bottom of this page, or request a paper application.

The information you share with us will remain confidential and will help us begin to get to know you and understand your current situation and what you hope to accomplish in your life while at Merci’s Refuge and beyond.  It will also help us determine if Merci’s Refuge is an appropriate program to meet your specific goals and provide for your needs.  If you have any questions or concerns while completing the application please contact us right away.


  1. Read the Program Overview, and Resident HandbookYou will be asked to sign contracts regarding these documents upon acceptance into the program.
  2. Complete the Merci’s Refuge Application online or request a paper copy. The entire application must be completed by the applicant.
  3. Obtain and submit treatment summaries from all mental health and/or substance abuse programs from the past 2 years and current immunization records. Please be sure to obtain all necessary items presented in the summary checklist below.
  4. Contact Merci’s Refuge staff to confirm your application forms have been received.  If you mail your application, please allow four days for delivery before calling, 217-378-4045.
  5. Once we receive and review your application, you will receive a phone call to schedule a telephone on in-person interview with a staff member. Interviews generally last 60 minutes and are scheduled in advance. Once the interview is completed, your application will be presented to our Intake Committee.
  6. The Intake Committee will determine each applicant’s acceptance or denial into the program. If accepted, a date of admission will be set. If no space is available, you will be placed on a waiting list and given further instructions. If denied, appropriate referrals will be given whenever possible.



  • Fill out your personal responses on the Merci’s Refuge Application.
  • Schedule a doctor’s appointment for a general physical.


  • Physician’s statement that you are physically and emotionally stable and appropriate to be admitted to a non-medical residential program
  • Current immunization records
  • Release(s) of Information
  • Treatment summaries from mental health &/or substance abuse programs (past 2 years)
  • Upon completion of the previous steps, send all information to Merci’s Refuge:
    Address: Merci’s Refuge, PO Box 1563, Champaign, IL 61824.
    Fax: 217 378-4051 Email: [email protected]
  • Call (217) 378-4045 to confirm that your application materials have been received.