305 Richmond Ave. East, Mattoon, IL 61938
Referral for Destination College
Destination College is a federally-funded TRiO Talent Search program designed to assist young people
who have academic potential to complete their middle and high school education and to pursue postsecondary
education or training after high school. One of the criteria necessary to be a participant in the Destination
College Program is that the student has potential to succeed in college or technical school. We are asking for
your help to determine if the student named below would be a good candidate for the Destination College
Program at Lake Land College. Your comments will be helpful in evaluating this student’s academic aptitude
and promise. Please return the form to: 305 Richmond Ave. East, Mattoon, IL 61938
Student’s Name:
(Last)
(First)
(Middle)
School:
Grade:
For each characteristic listed below, please check () the appropriate rating.
CHARACTERISTICS
EXCELLENT
GOOD
AVERAGE
POOR
NO BASIS
TO JUDGE
Sense of responsibility
Level of academic motivation
Potential for postsecondary enrollment
School attendance
1. Do you recommend this student to participate in the TRIO ETS program?

Enthusiastically

Fairly Strongly

Without Enthusiasm

Not Recommended
Please Explain:
2. Do you recommend this student receive tutoring services?

YES

NO
If yes, in what areas?
Additional comments:
Name:
Signature:
Title
Date:
Approved 10/2012