Application for the Refuge Online Program

There are several ways to apply:

Press the "Download the Application" button below to download or print; then email, fax, or mail to us.

  • Email:
  • Fax Number:
  • Mailing Address:
    Women's Refuge
    P.O. Box 1484
    Vero Beach, FL 32961

Download the Application to email, fax or mail Download-Online-Application

Steps to being accepted to the Women’s Refuge online program:

  1. Please complete the application.
  2. Once your application is received, we will review the application, and usually within 48 hours, our counseling staff will contact you.

If you have special circumstances, please call us to fill out an application over the phone 772-770-4424.