Lake Land College-TS-Application Form

TRIO Destination College Application

Why should you be a part of Destination College?

The TRiO Destination College team believes that every student CAN go to college. Our goal is to help middle/junior high school and high school students like you build a pathway to college and career goals!

We hold regular events and visit your school to support you on your journey. Join us to define success your way and reach your goal of attending college.

WE CAN HELP YOU!
- Reach college step by step
- Join virtual and face to face club meetings to meet new friends and explore colleges and careers
- Find money for college and learn how to manage it
- Get FREE online tutoring
- Complete college, scholarship and financial aid applications
Testimonials from TRiO Students
- “I am glad that I am in TRiO because if not I would be missing out” -Student from Ramsey Junior High School
- “TRiO is fun, and helped me gather info about college and more things I needed to know” -Student from St. Elmo Junior High School
- “I enjoyed that I am learning more about my future options while having fun.” -Student from Paris Mayo Middle School
FREE services offered to all participants:
- Monthly meetings/workshops at school
- Trips and college visits
- Help with college and financial aid applications
- Connections to tutoring
- ACT prep courses
- Parent workshops
- Leadership opportunities
CONTACT:

Lori Ohnesorge
Director of TRiO Destination College
Lake Land College
217-234-5048
lakelandcollege.edu/triodc
facebook.com/triodc

APPLY TODAY!

Household Information
Student lives with

Natural Parents Natural Parent & Step-parent Single Parent Legal Guardian/Foster Parent
Parent/Guardian Information
Name *

First Name Middle Initial Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Employer
Job Title
Cell Phone
(999)999-9999
Primary Phone (if different)
(999)999-9999
Do you have another child in the Destination College program or any other TRiO program?

Yes No
If yes, which school does the student attend.

If the student has sibling in grades 6-12 not in the program please list them:

Name(s) of Sibling(s)

Grade

School

Education & Income Verification
Lake Land College Destination College, a Talent Search project, is required by the US Department of Education to verify educational background and household income level for all participants. (34CFR643.10) All information will be held in strict confidence, and we will adhere to the Family Educational Rights and Privacy Act of 1974 (FERPA).
Taxable Income is usually lower than the Total or Gross Income. Please call 217-234-5003 or 217-234-5048 if you have any questions or need assistance locating this information. If possible, please include a copy of your tax form with application. 34CFR643.7
1. Did either of the applicant's parents, who live with the applicant, earn a baccalaureate degree (4-year degree) or higher (Please do not answer for natural parents who do not live with the applicant, stepparents, grandparents or legal guardians)? *

Yes No
2. Please provide the number of members in your household. Include yourself and anyone supported by your income. *
3A. My household's Annual Gross Income for the previous year was – please provide an amount
3B. My household's Annual Taxable Income (after deductions) for the previous year was – please provide an amount *
3C. I have no taxable income and am not required to file a tax return

Yes No
4. Is the applicant in foster care and/or ward of the state of Illinois? *

Yes No
I certify that the information provided is true and accurate to the best of my knowledge.
Parent/Guardian Signature *

Clear
Date

Month Day Year
mm-dd-yyyy

Release Statement & Agreement
Please read carefully and sign where indicated. Failure to provide a signature will delay processing of the application.
- I hereby authorize the release of all secondary & post-secondary school records to the Destination College program.
- I authorize Destination College to share and discuss any information with my parents or legal guardians.
- I understand that all information on this application as well as that released from the school will be held in strict confidence by Destination College.
- I give permission to Destination College to take photographs during activities, trips, events and to use my child’s name and/or photo for Destination College educational and/or promotional purposes.
- Our signatures below indicate our commitment to our child’s education and Destination College.
- I understand that this authorization remains in effect while a participant in Destination College and through post-secondary education. I will provide Destination College with written notice to revoke the authorization.
Student's Printed Name *

First Name Last Name
Student's Signature *

Clear
Date

Month Day Year
mm-dd-yyyy
Parent or Guardian's Printed Name *

First Name Last Name
Parent/Guardian Signature *

Clear
Date

Month Day Year
mm-dd-yyyy
Please check this box if you do NOT want TRiO Destination College to take photos of your child during activities and trips.

I do NOT want TRiO Destination College to take photos of my child during activities and trips.