Need help?

We are accepting applications on behalf of survivors from advocates, case workers, and partner organizations. 

Select the appropriate form below.


  • Your advocate or case worker will submit a referral request that will be reviewed by our National office. 
  • Your advocate or case worker will be contacted by our National office within 48 hours (M-F) with next steps.
  • If the initial screen suggests that you are eligible for our program, your advocate or case worker will be sent a link for the full application.
  • Once the full application is received, you will be contacted within 48 hours (M-F) by someone on our National Intake team to conduct an interview.
  • Your application will be sent to a Refuge for Women home in a location with an open bed based on the outcome of the initial interview.
  • You will be contacted by the Program Director of the open bed location within 48 hours (M-F) of them receiving your application.
  • Based on the outcome of that interview, plans will be made for your arrival.
  • The entire process, from application to determination, is approximately 3-5 business days.


If you need immediate help in your current situation, please visit our list of Resources for Help here.