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Breakthrough Providence Student Application

Application Deadline: Rolling Decision

Hello and thank you for your interest in Breakthrough Providence. Within this application, we ask that you provide information that Breakthrough Providence can use to best serve you. The sections within this application include:

Section 1: Student Information
Section 2: Student Short-Answer Question
Section 3: Family Information
Section 4: Teacher Recommendation Form

If there is any questions or concerns, send an email to Jerome R. Thompson, Middle School Program Director at jthompson@breakthroughprovidence.org

¡Hola y gracias por su interés en Breakthrough Providence. Dentro de esta aplicación, le pedimos que brinde información que Breakthrough Providence pueda usar para brindarle el mejor servicio. Las secciones dentro de esta aplicación incluyen:

Sección 1: Información del Estudiante 
Sección 2: Información del la Familia
Sección 3: Pregunta de Respuesta Breve del Estudiante
Sección 4: Formulario de Recomendación del/de la Maestro/a

Si tiene alguna pregunta o inquietud, envíe un correo electrónico a Jerome R. Thompson, Director del Programa de Escuelas Intermedias a jthompson@breakthroughprovidence.org




Breakthrough is committed to selecting a class of students who approximate the ethnic, racial, religious and cultural diversity of our city.  Breakthrough accepts students regardless of race, creed or color; we are committed to selecting a diverse group of students who benefit from the program.


Selection Timeline for Summer 2021:


Online Application and Parent / Guardian Packet Due Date: We are now accepting applications on a rolling basis






Breakthrough Site Information:

216 Hope St Providence, RI 02906 - Jerome Thompson jthompson@breakthroughprovidence.org

 

   

Providence- new

Student Section: We are interested in getting to know each student who applies to Breakthrough so this section should ONLY BE COMPLETED BY THE STUDENT.  If you have any questions as you complete this portion of the application, please reach out to an adult.

Student Contact Information

Student Section: We are interested in getting to know each student who applies to Breakthrough so this section should ONLY BE COMPLETED BY THE STUDENT.  If you have any questions as you complete this portion of the application, please reach out to an adult.

Teacher or Other Recommenders
It is helpful for us to understand more about who you are as a student, by connecting with a Teacher/Staff Member that knows you well. Please provide us with the name or contact information of someone you would like to provide a recommendation on your behalf, so we can reach out. Your parent / guardian will be asked to provide their email addresses in the parent section of the application.
Please provide the teacher's full name.
Please provide the teacher's full name.
Breakthrough History

Names of family members, teachers, etc.
School Information
ID number issued to you by the school or district.
Short Answer Questions:  Please answer all of the questions below using at least 4 sentences.  We want to see your best work!  You may copy/paste from a word document if you like.
1.  Breakthrough is an opportunity to grow academically, socially, and personally. What areas of growth would you focus on personally at Breakthrough and why?
Your answer is required in order to submit.
2.  What​ ​does​ ​being​ ​a​ ​leader​ ​mean​ ​to​ ​you?​ ​Describe​ ​a​ ​time​ ​when​ ​you​ ​were​ ​a​ ​leader.
Your answer is required in order to submit.
3.  Breakthrough is a long-term commitment. See program description for a full explanation of the commitment. Why do you want to be a part of Breakthrough, and why do you feel ready for this commitment? What do you hope to gain?
Your answer is required in order to submit.
Essay:  Please answer the questions below using 250 words or less.  We want to see your best work!  You may copy/paste from a word document if you like.
1. If you could fast-forward into the future and see yourself, where do you think you will be in the next 10-15 years? What kinds of things will you be doing?  What type of job will you have? How will you achieve these goals? Where will you be living? Describe in detail what your life will be like in the future.
Your answer is required in order to submit.

Family Section: This section of the application should ONLY BE COMPLETED BY A PARENT / GUARDIAN.

I would like to complete the Parent section the following language. 
Me gustaría completar la sección de padres en el siguiente idioma.

Please click the circle ONCE to select a language and then it will take about 10 seconds for the circle to darken and for the remainder of the form to load in your selected language.  Thank you!


Por favor oprima el círculo para elegir el idioma UNA VEZ. Después de seleccionar el idioma preferido, pasarán 10 segundos antes de que el círculo se oscurezca y la aplicación aparezca en el idioma indicado.  Muchas gracias por su paciencia. 




Parent / Guardian Contact Information
Press Ctrl to select multiple options
Press Ctrl to select multiple options

Employment History

Education History

Home Language

Please select all that apply.

Relationship Details

Información de contacto del padre/guardián (Parent / Guardian Contact Information - Spanish)
First Name
Last Name
Gender
Birth Country
Home Address Street
Home Address City
Home Address State
Home Address Zip Code
My address is the same as the student
Parent Email Address
Home Phone
Cell Phone
Work Phone
Preferred means of contact
Please select the best day(s) to contact you. Press Ctrl to select multiple options
Please select the best time(s) to contact you. Press Ctrl to select multiple options.

Historial de empleo (Employment History)

Employment status
Employer name
Years with company or organization
Work Hours

Historial educativo (Education History)

Highest level of education completed
Country of bachelor’s degree
Country of master’s/professional/doctoral degree
Country of highest level of education

Idioma del hogar (Home Language)

Is English your student's primary language?
What languages are regularly spoken in your home? Please select all that apply.
Specify home language(s)
How often do you speak English with your child at home?
What was the first language your child learned to speak?
How comfortable are you with English?
Would you need documents and communication to be translated for you?

Detalles de la relación (Relationship Details)

What is your relationship to the student?
Do you have a spouse or partner who lives in the same household as you and your student?
What is your spouse/partner's relationship to the student?
Is there any other adult(s) involved in the student's upbringing or living in your home that we should be in contact with?
Please provide details
How much of the time does your student live with you?
Does student receive additional financial support from another parent or guardian?
Where does the student live when not living with you?
If you selected "other" for the question above, please explain
Lời tuyên bố của phụ huynh/ người giám hộ (Parent/Guardian Information - Vietnamese)


Hướng dẫn: Biểu mẫu này dành cho phụ huynh hoặc người giám hộ của học sinh để hoàn thành. Xin vui lòng nộp biểu mẫu này với đơn đăng kí của học sinh. Tại sao chúng tôi hỏi những câu hỏi này? Yếu tố chính mà chúng tôi xem xét trong mỗi đương đơn là động lực. Tuy nhiên, chúng tôi cũng xem xét những yếu tố khác như học sinh có phải là thế hệ đầu tiên trong gia đình đi đại học. Mặc dù những yếu tố này có thể ảnh hưởng đến quyết định của chúng tôi, nhưng chúng không đảm bảo hoặc loại bỏ đơn học sinh. Những câu hỏi này sẽ không được chia sẻ với bất cứ ai bên ngoài chương trình BreakthroughXin lưu ý rằng chương trình này chỉ dành cho học sinh học lớp 6. 

First Name
Last Name
Gender
Birth Country
Home Address Street
Home Address City
Home Address State
Home Address Zip Code
My address is the same as the student
Parent Email Address
Home Phone
Cell Phone
Work Phone
Preferred means of contact
Please select the best day(s) to contact you. Press Ctrl to select multiple options
Please select the best time(s) to contact you. Press Ctrl to select multiple options.

Lich sử công việc (Employment History)

Employment status
Employer name
Years with company or organization

Lịch Sử học vấn (Education History)

Highest level of education completed
Country of bachelor’s degree
Country of master’s/professional/doctoral degree
Country of highest level of education
Please specify country of education
Ngôn ngữ ở nhà (Home Language)
What languages are regularly spoken in your home? Please select all that apply.
Specify home language(s)
How often do you speak English with your child at home?
What was the first language your child learned to speak?
How comfortable are you with English?
Would you need documents and communication to be translated for you?
Chi tiết mối quan hệ (Relationship Details)
Do you have a spouse or partner who lives in the same household as you and your student?
What is your relationship to the student?
What is your spouse/partner's relationship to the student?
Is there any other adult(s) involved in the student's upbringing or living in your home that we should be in contact with?
Please provide details
How much of the time does your student live with you?
Does student receive additional financial support from another parent or guardian?
Where does the student live when not living with you?
If you selected "other" for the question above, please explain
Parent / Guardian #2 Contact Information
Press Ctrl to select multiple options
Press Ctrl to select multiple options

Employment History

Education History

Please select all that apply.
Información de contacto del otro padre/guardián (Parent / Guardian #2 Contact Information - Spanish)
First Name
Last Name
Gender
Gender Specify
Birth Country
Home Address Street
Home Address City
Home Address State
Home Address Zip Code
Home Phone
Cell Phone
Work Phone
Email Address
What is their relationship to the student?
How much of the time does your student live with them?
Preferred means of contact
Please select the best day(s) to contact you. Press Ctrl to select multiple options
Please select the best time(s) to contact you. Press Ctrl to select multiple options.

Historial de empleo (Employment History)

Employment status
Employer name
Years with company or organization
Work Hours

Historia educativo (Education History)

Highest level of education completed
Country of bachelor’s degree
What year were they last enrolled in college
What year did they complete your bachelor’s degree?
Country of master’s/professional/doctoral degree
Country of highest level of education
Please specify country of education
What languages are regularly spoken in your home? Please select all that apply.
Specify home language(s)
How often do they speak English with your child at home?
What was the first language your child learned to speak?
How comfortable are they with English?
Would they need documents and communication to be translated for you?
Thông tin hụ huynh/người giám hộ #2  (Parent / Guardian #2 Contact Information - Vietnamese)
First Name
Last Name
Gender
Gender Specify
Birth Country
Home Address Street
Home Address City
Home Address State
Home Address Zip Code
Home Phone
Cell Phone
Work Phone
Email Address
What is their relationship to the student?
How much of the time does the student live with them?
Preferred means of contact
Please select the best day(s) to contact you. Press Ctrl to select multiple options
Please select the best time(s) to contact you. Press Ctrl to select multiple options.

Lịch sử công việc (Employment History - Vietnamese)

Employment status
Employer name
Years with company or organization

Lịch Sử học vấn  (Education History)

Highest level of education completed
Country of bachelor’s degree
Country of master’s/professional/doctoral degree
Country of highest level of education
What languages are regularly spoken in your home? Please select all that apply.
Specify home language(s)
How often do they speak English with your child at home?
How comfortable are they with English?
Would they need documents and communication to be translated for you?

Family Section: This section of the application should ONLY BE COMPLETED BY A PARENT / GUARDIAN.  Breakthrough will review all information carefully, confidentially, and holistically.

Breakthrough History

Names of family members, teachers, etc.

Historal de Breakthrough (Breakthrough History - Spanish)

How did you hear about Breakthrough?
Other - please explain
Please provide details on how you heard about Breakthrough. Names of family members, teachers, etc.
Do you have any other children in the program or who has/have completed the program?
Other Student Name
Other Student Birthdate
Other Student Grade
Other Student Breakthrough Site

Lịch sử Breakthrough (Breakthrough History - Vietnamese)

How did you hear about Breakthrough?
Other - please explain
Please provide details on how you heard about Breakthrough. Names of family members, teachers, etc.
Do you have any other children in the program or who has/have completed the program?
Other Student Name
Other Student Birthdate
Other Student Grade
Other Student Breakthrough Site

Family Background
Antecedentes de Familia (Family Background - Spanish)
What is total pre-tax income last year
How many people living in your household are under the age of 18?
How many people in your household are 18 years of age or older?
Is your monthly income fixed or flexible?
Please upload your 1040 (optional):
Has anything happened in the last year that has impacted the accuracy of the information provided on your current financial situation?
Hoàn Cảnh Gia Đình (Family Background - Vietnamese)
Is your monthly income fixed or flexible?
What is your total pre-tax income last year
How many people living in your household are under the age of 18?
How many people in your household are 18 years of age or older?
Please upload your 1040 (optional):
Has anything happened in the last year that has impacted the accuracy of the information provided on your current financial situation?

Family Section: This section of the application should ONLY BE COMPLETED BY A PARENT / GUARDIAN.  Breakthrough will review all information carefully, confidentially, and holistically.

Student Background

You may choose more than one.
Hold down the Ctrl button to choose more than one.
Can be specific ethnicity (Hmong, Chinese, Nigerian), religious affiliation (Muslim, Jewish, Jain), or any other community your student identifies with.

Check all that apply.
Examples: Sports, Avid, Boys and Girls Club, Religious Activities, etc.


If applicable (i.e. speech therapy, extra tutoring, medication, any accomodations, IEP, 504 Accomodation plans, RSP, etc.)
Antecedentes del estudiante (Student Background - Spanish)
Does your student qualify for Free and Reduced Price Lunch?
Is your student Hispanic or Latino/a?

Which of the following choices describe your student's race? You may choose more than one.
Please specify student's country/ies of origin. Hold down the Ctrl button to choose more than one.
Please list or describe any other communities your student identifies with. Can be specific ethnicity (Hmong, Chinese, Nigerian), religious affiliation (Muslim, Jewish, Jain), or any other community your student identifies with.
How will your student get to/from Breakthrough?

Other transport:
Breakthrough provides students with access to public transportation, but students often travel to and from the program alone. Would you allow your child to travel alone on public transportation:
Ejemplos: Deportes, Avid, Boys and Girls Club, actividades religiosas, etc. Does your student currently participate in any other programs or activities?Examples: Sports, Avid, Boys and Girls Club, Religious Activities, etc.

Please describe your student's other commitment(s). How many hours per week does your student dedicate to each activity and how flexible are these commitments?
Do you foresee any conflicts with the dates of the program?

Please explain conflicts/concerns:
To ensure that your child receives the consideration, support and encouragement they need while in Breakthrough, please share any educational support your student has or is currently receiving. If applicable (i.e. speech therapy, extra tutoring, medication, any accomodations, IEP, 504 Accomodation plans, RSP, etc.)
Please describe educational support
Breakthrough is a rigorous 6-year academic commitment. How will you help your student fulfill this commitment? Please explain.
Please upload a student photo (optional)
Hoàn Cảnh Học Sinh (Student Background - Vietnamese)
Does your student qualify for Free and Reduced Price Lunch?
Is your student Hispanic or Latino/a?

Which of the following choices describe your student's race? You may choose more than one.
Please specify student's country/ies of origin. Hold down the Ctrl button to choose more than one.
Please list or describe any other communities your student identifies with. Can be specific ethnicity (Hmong, Chinese, Nigerian), religious affiliation (Muslim, Jewish, Jain), or any other community your student identifies with.
How will your student get to/from Breakthrough?

Other transport:
Breakthrough provides students with access to public transportation, but students often travel to and from the program alone. Would you allow your child to travel alone on public transportation:
Ví dụ: Thể thao, Avid, Boys and Girls Club, Hoạt Động Tôn Giáo, vv. Does your student currently participate in any other programs or activities?Examples: Sports, Avid, Boys and Girls Club, Religious Activities, etc.

Please describe your student's other commitment(s). How many hours per week does your student dedicate to each activity and how flexible are these commitments?
Do you foresee any conflicts with the dates of the program?

Please explain conflicts/concerns:
To ensure that your child receives the consideration, support and encouragement they need while in Breakthrough, please share any educational support your student has or is currently receiving. If applicable (i.e. speech therapy, extra tutoring, medication, any accomodations, IEP, 504 Accomodation plans, RSP, etc.)
Please describe educational support
Breakthrough is a rigorous 6-year academic commitment. How will you help your student fulfill this commitment? Please explain.
Please upload a student photo (optional)

Family Section: This section of the application should ONLY BE COMPLETED BY A PARENT / GUARDIAN.  Breakthrough will review all information carefully, confidentially, and holistically.

Short Answer Questions: Help us get to know your student by responding to the questions below.  You may copy/paste from a word document if you like.
1.  Tell us why YOU, as the parent(s)/guardian(s) want to be part of the Breakthrough community and why you think it is important for your child to attend a 4-year college or university?
2.  Breakthrough is looking for students who are committed to themselves, their academics, and to all responsibilities. Please tell us why you think your child is a dedicated and committed student. Please share any examples to support your ideas.
3.  Please share your own educational journey with us.  What obstacles, if any, did you experience, that prevented you from pursuing higher education or a college degree?
Preguntas de respuesta corta: ayúdenos a conocer a su estudiante respondiendo a las siguientes preguntas (Short Answer Questions - Spanish)
1.  Díganos por qué USTED, como padre(s)/guardián(es) quiere(n) ser parte de la comunidad de Breakthrough y por qué cree que es importante que su hijo/a asista a un colegio o una universidad de 4 años?
Tell us why YOU, as the parent(s)/guardian(s) want to be part of the Breakthrough community and why you think it is important for your child to attend a 4-year college or university?
2.  Breakthrough busca estudiantes comprometidos a ellos mismos, a sus estudios,  y a todos sus responsabilidades. Por favor díganos por que cree que su hijo/a es un estudiante dedicado/a y comprometido/a. Por favor comparta cualquier ejemplo para apoyar su respuesta.
Breakthrough is looking for students who are committed to themselves, their academics, and to all responsibilities. Please tell us why you think your child is a dedicated and committed student. Please share any examples to support your ideas.
3.  Por favor comparte su propio viaje educativo con nosotros. Qué le impidió obtener una educación superior o un título universitario?
Please share your own educational journey with us. What obstacles, if any, did you experience, that prevented you from pursuing higher education or a college degree?
Những câu trả lời ngắn: Giúp chúng tôi tìm hiểu thêm về học sinh của bạn bằng cách trả lời các câu hỏi bên dưới (Short Answers - Vietnamese)
1.  Hãy nói cho chúng tôi biết tại sao BẠN, với tư cách là cha mẹ/ người giám hộ muốn là một phần của Breakthrough và tại sao bạn nghĩ rằng điều quan trọng đối với con bạn là được đi học đại học 4 năm?
Tell us why YOU, as the parent(s)/guardian(s) want to be part of the Breakthrough community and why you think it is important for your child to attend a 4-year college or university?
2.  Breakthrough đang tìm kiếm những học sinh có trách nhiệm với bản thân, với việc học hành và với mọi trách nhiệm khác. Hãy cho chúng tôi biết tại sao bạn nghĩ con bạn là một học sinh có trách nhiệm. Xin hãy chia sẻ ví dụ hỗ trợ ý kiến của bạn.
Breakthrough is looking for students who are committed to themselves, their academics, and to all responsibilities. Please tell us why you think your child is a dedicated and committed student. Please share any examples to support your ideas.
3.  Xin hãy chia sẻ hành trình giáo dục của bạn với chúng tôi. Có bất kì trở ngại nào mà bạn đã trải qua đã ngăn bạn theo học bằng cao đẳng hay đại học không?
Please share your own educational journey with us. What obstacles, if any, did you experience, that prevented you from pursuing higher education or a college degree?
Student School Information
Información de la escuela del estudiante (Student School Information - Spanish)
Name of student's current school
Will the student be attending the same school next year
Student's new school name
Please list the school counselor who will send your student's grades/test scores.
Thông tin trường hoc (Student School Information - Vietnamese)
Name of student's current school
Will the student be attending the same school next year
Student's new school name
Please list the school counselor who will send your student's grades/test scores.
Recommendation Information: It is helpful for us to understand more about your child as a student, by connecting with a Teacher/Staff Member that knows you well. Please provide us with the name or contact information of someone you would like to provide a recommendation on your behalf, so we can reach out. 

Teacher 1
If this name is incorrect or mispelled, please correct under the student section on page 3 of this form.
Teacher 2
If this name is incorrect or mispelled, please correct under the student section on page 3 of this form.
Información de recomendación: Es útil para nosotros entender más sobre quién es usted como estudiante, al conectarse con un maestro/miembro del personal que lo conoce bien. Indíquenos el nombre o la información de contacto de alguien a quien le gustaría brindar su recomendación, para que podamos comunicarnos con usted.

Maestro 1
Recommender's Name. If this name is incorrect or mispelled, please correct under the student section on page 3 of this form.
Recommender's Emai
Maestro 2
Recommender's Name. If this name is incorrect or mispelled, please correct under the student section on page 3 of this form.
Recommender's Email
Thông tin giới thiệu: Chương Trình Breakthrough Thung lũng Silicon yêu cầu hai người giới thiệu như là một phần của quá trình đăng ký. Nếu con bạn học trong học khu Franklin McKinley, hai người giới thiệu có thể là hai giáo viên hoặc một giáo viên và một người làm giáo dục (ví dụ: người cố vấn học sinh, hiệu trưởng). Nếu con bạn theo học ở học khu San Jose Unified, hai người giới thiệu phải là MỘT giáo viên toán và MỘT giáo viên ngữ văn. Học sinh đã cung cấp tên, vui lòng cung cấp địa chỉ email và chúng tôi sẽ liên hệ với các giáo viên trực tiếp qua email. (Recommenders - Vietnamese)

Giáo Viên 1 (Teacher 1)
Recommender's Name. If this name is incorrect or mispelled, please correct under the student section on page 3 of this form.
Recommender's Emai
Giáo Viên 2 (Teacher 2)
Recommender's Name. If this name is incorrect or mispelled, please correct under the student section on page 3 of this form.
Recommender's Email
Breakthrough Expectations
At Breakthrough Providence (BTP), we want to help students reach their academic goals. This process is effective when students and their families maintain a series of expectations to help their students succeed in our program. These include: 

  • Support, uphold, and reinforce your student’s two-year commitment to BTP.
  • Ensure student’s consistent participation in BTP throughout the Academic Summer Session with regular participation and adhering to the Attendance Policy.
  • Schedule vacations around the dates of the program, and schedule appointments outside of the Breakthrough Providence scheduled sessions.
  • Establish routines at home that support your child’s academic pursuits, i.e. encourage students to complete online assignments before watching TV, check to make sure online assignments are complete, make sure your student gets 8-10 hours of sleep. 
  • Maintain regular contact with the Breakthrough Providence staff as a source for support, advocacy, and resources relating to your child’s education. 

By checking the box below, you are acknowledging that you understand the expectations Breakthrough has for its students and families accepted into its program.
Expectativas de Breakthrough (Breakthrough Expectations - Spanish)
En Breakthrough Providence (BTP), queremos ayudar a los estudiantes a alcanzar sus metas académicas. Este proceso es efectivo cuando los estudiantes y sus familias mantienen una serie de expectativas para ayudar a sus estudiantes a tener éxito en nuestro programa. Éstos incluyen:

Apoye, defienda y refuerce el compromiso de dos años de su estudiante con BTP.
Asegurar la participación constante del estudiante en BTP durante la sesión académica de verano con participación regular y adherirse a la política de asistencia.
Programe las vacaciones alrededor de las fechas del programa y programe citas fuera de las sesiones programadas de Breakthrough Providence.
Establezca rutinas en casa que apoyen las actividades académicas de su hijo, es decir, anime a los estudiantes a completar las tareas en línea antes de ver la televisión, verifique que las tareas en línea estén completas, asegúrese de que su estudiante duerma de 8 a 10 horas.
Mantenga un contacto regular con el personal de Breakthrough Providence como una fuente de apoyo, defensa y recursos relacionados con la educación de su hijo.

Al marcar la casilla a continuación, reconozco que entiendo que el programa es un compromiso de seis años y que estamos entusiasmados de participar y recibir el apoyo necesario para asegurar que nuestro hijo/a se inscriba en una universidad de cuatro años después de la escuela secundaria.
I understand the expectations of Breakthrough.
Kỳ vong của Breakthrough (Breakthrough Expectations - Vietnamese)
Affiliate specific expectations language...

Bằng cách chọn ô dưới đây, tôi xác nhận rằng tôi hiểu được chương trình là một cam kết kéo dài sáu năm và chúng tôi rất hào hứng tham gia và nhận được sự hỗ trợ cần thiết để đảm bảo con của chúng tôi đi học trường đại học bốn năm sau trung học
I understand the expectations of Breakthrough.

Please review the information and make sure it is accurate. It may take up to 1 minute for the application to process before you see the confirmation screen.  Please do not hit submit a second time.  Thank you for your patience!