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Student Application

Application Deadline: March 19, 2021

Thank you for your interest in Breakthrough! Students and parents should carefully read all of the information below.

Prospective families are asked to complete the following to be considered for Breakthrough:

1) Online application

Student Section (to be completed by the student)
Family Section (to be completed by the parent/guardian)
Teacher recommendations (2) (you will provide their email addresses and we will contact them directly)

AND

2) Supplemental Documents (can be uploaded to the online application or submitted directly to the site which you are applying)

Photograph of the Student
Most Recent FSA / Standardized Test Scores

5th- 7th Grade Applicants:

PUBLIC SCHOOL STUDENTS
- Most recent FSA Scores (3rd, 4th or 5th grade scores)
PRIVATE SCHOOL STUDENTS
- Submit most recent Standardized Test Scores from your school

Student Transcripts for Current & Previous Year
Mutual Exchange of Information Form

Supplemental Documents should be uploaded to the online application or submitted to the designated Breakthrough Miami site to which you are applying to. Site assignments are determined by a student's zip code. Office locations are listed below as well as on the Breakthrough Miami website.

Once all application materials are received, our team will review all information carefully, confidentially, and holistically.

Breakthrough Miami is committed to selecting a class of students who approximate the ethnic, racial, religious and cultural diversity of Miami. Breakthrough Miami 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:

Early Action Deadline: January 15, 2021

Early Action Admission Letters: February 25th and 26th, 2021

Regular Decision Deadline: April 2, 2021

Regular Decision Admission Letters: May 6th and 7th, 2021

Breakthrough Site Information:

Carrollton School of the Sacred Heart

3747 Main Highway Miami, FL 33133- liz@breakthroughmiami.org

Gulliver Schools:

6575 North Kendall Drive Pinecrest, FL 33156 - frederick@breakthroughmiami.org

Miami Country Day School:

601 NE 107th Street Miami, FL 33161 - kenneth@breakthroughmiami.org

Palmer Trinity School:

7900 SW 176th Street Palmetto Bay, FL 33157 - jonah@breakthroughmiami.org

Ransom Everglades:

2045 South Bayshore Drive, Miami, FL 33133 - webber@breakthroughmimi.org

PLEASE NOTE: Breakthrough Miami, Ransom Everglades will be accepting Supplemental Documents for BOTH Breakthrough Miami, Ransom Everglades and Breakthrough Miami, Carrollton School of the Sacred Heart.

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. Student Short Answer questions MUST 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

First Name:

Middle Name:

Last Name:

Preferred Name/ Nickname:

Email Address:

Leave this blank if you don't have an email address

Home Phone:

Cell Phone:

Gender:

Gender Specify:

Birth Date:

Birth Country:

Home Address Street:

Leave this blank if you aren't sure about your address

Home Address City:

Home Address State:

Home Address Zip Code:

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. Student Short Answer questions MUST be completed by the student. If you have any questions as you complete this portion of the application, please reach out to an adult.

Breakthrough History

1. How did you hear about Breakthrough?

Breakthrough presentationBreakthrough staff memberFamily connectionTeacherBreakthrough studentOther

1a. Other - please explain:

1b. Please provide details on how you heard about Breakthrough:

Names of family members, teachers, etc.

2. Are you the sibling of or related to a Breakthrough student?

2a. What is their full name?

2b. What's your relationship (e.g. brother, sister, cousin)?

School Information

1. Current Grade:

2. How difficult is your current school work?

3. Your student School ID number:

ID number issued to you by the school or district.

Teacher Recommenders

Breakthrough Miami requires 2 teacher recommendations as part of the application process. One recommendation from your Math teacher and one from your Reading/Language Arts teacher. Please list the teachers who will provide your recommendations. Your parent / guardian will be asked to provide their email addresses in the family section of the application.

Teacher 1:

Please provide the teacher's full name.

Teacher 2:

Please provide the teacher's full name.

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

Short Answer Questions: Please answer all of the questions below using at least 4-6 sentences. We want to see your best work! You may copy/paste from a word document if you like.

1. If you were the Principal of your school, how would you change things?

Your answer is required in order to submit.

2. What is one thing that would make your life easier? Is it something you can achieve?

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. NOT BEING USED BY MIAMI IN 2019, but keep as placeholder for future.

Your answer is required in order to submit.

2. NOT BEING USED BY MIAMI IN 2019, but keep as placeholder for future.

Your answer is required in order to submit.

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

In addition to the online application, you must also submit a Parent Packet (see page 1 for complete details) which includes: 1) Photograph of the Student 2) Most Recent FSA/Standardized Test Scores 3) Student Transcripts for Current & Previous Year 4) Mutual Exchange of Information.

Once all the application materials are received, our team will review all information carefully, confidentially, and holistically.

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

Parent / Guardian Contact Information

First Name:

Last Name:

Gender:

Gender Specify:

Birth Country:

My address is the same as the student

Home Address Street:

Home Address City:

Home Address State:

Home Address Zip Code:

Home Phone:

Cell Phone:

Work Phone:

Parent Email Address:

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

Employment History

Employment status:

Employer name:

Years with company or organization:

Work Hours:

Education History

Highest level of education completed:

What year were you last enrolled in college:

Country of bachelor’s degree:

What year did you complete your bachelor’s degree?

Country of master’s/professional/doctoral degree:

Country of highest level of education:

Please specify country/countries of highest level of education:

Home Language

Is English the primary language spoken by the student? (Note: If your child's home language is not English you would likely select "No" as the response for this question.)

What languages are regularly spoken in your home?

EnglishSpanishAn African language (Example: Amharic, Swahili, Yoruba)A Southeast Asian language (Example: Combodian, Hmong, Karen, Vietnamese)A South Asian language (Example: Hindi, Pashto, Tamil, Urdu)Another Asian language (Example: Japanese, Korean)A Middle Eastern language (Example: Arabic, Farsi)A Filipino languageA European language other than Spanish (Example: French, German, Russian)A Chinese languageA Caribbean language (Example: Haitian Creole, Papiamento)Another languageDecline to AnswerPlease 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?

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 your spouse or partner a legal guardian of the student?

Yes

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?

Please explain any additional things to know about the student's family or family structure below:

Other Parent / Guardian Contact Information

I am only comfortable providing basic contact information on behalf of the 'Other Parent / Guardian'.

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:

Preferred means of contact:

Relationship Details

What is their relationship to the student?

How much of the time does the student live with them?

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

Employment History

Employment status:

Employer name:

Years with company or organization:

Work Hours:

Education History

Their highest level of education completed:

What year were they last enrolled in college:

Country of bachelor’s degree:

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:

Home Language

What languages are regularly spoken in their home?

Specify home language(s):

How often do they speak English with your child at their home?

How comfortable are they with English?

Would they need documents and communication to be translated?

Additional Parent / Guardian Contact Information

First Name:

Last Name:

Gender:

Gender Specify:

Birth Country:

Cell Phone:

Work Phone:

Email Address:

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

Employment History

Employment status:

Employer name:

Years with company or organization:

Work Hours:

Education History

Highest level of education completed:

What year were they last enrolled in college:

Country of bachelor’s degree:

What year did they complete their bachelor’s degree?

Country of master’s/professional/doctoral degree:

Country of highest level of education:

Please specify country of education:

Home Language

How comfortable are they with English?

Would they need documents and communication to be translated?

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

Breakthrough History

1. How did you hear about Breakthrough?

From my childBreakthrough presentationBreakthrough staff memberFamily connectionTeacherBreakthrough studentOther

1b. Other - please explain:

1b. Please provide details on how you heard about Breakthrough:

Names of family members, teachers, etc.

2. 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

1. Is your monthly income fixed or flexible?

2. What is your ANNUAL pre-tax household income for last year:

*I need help calculating my ANNUAL pre-tax household income.

Annual Household Income Estimator

Need help figuring out your annual pre-tax household income? Input your average monthly income and the number of months you worked last year in the boxes below to get an estimated calculation.

What is your Average MONTHLY pre-tax household income for last year:

How many months did you work last year?

ESTIMATION: Based off your monthly income, this is what we have estimated to be your ANNUAL pre-tax household income for last year. Please enter this number in Question 2 above.

3. How many people living in your household are under the age of 18?

4. How many people in your household are 18 years of age or older?

5. Please upload your 1040 (optional):

6. 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 Miami will review all information carefully, confidentially, and holistically.

Student Background

1. Does your student qualify for Free and Reduced Price Lunch?

2. Is your student Hispanic or Latino/a?

3. Which of the following choices describe your student's race?

Alaska NativeAmerican IndianAsian or Asian AmericanBlack or African AmericanMiddle EasternMultiracialNative HawaiianPacific IslanderWhite or CaucasianOtherDecline to AnswerYou may choose more than one.

4. Please specify student's country/ies of origin:

Type first letter to find country more quickly. Hold down the Ctrl button to choose more than one.

5. Please list or describe any other communities your student identifies with:

Can be specific ethnicity (Haitian, Hmong, Chinese, Nigerian), religious affiliation (Muslim, Jewish, Jain), or any other community your student identifies with.

6. How will your student get to/from Breakthrough?

Breakthrough Miami offers FREE transportation for its scholars.

6a. Other transport:

7. 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:

During School Year in the evenings (6:00 pm)?During Summers?I do not want my child to travel alone on public transit.Check all that apply.

8. Does your student currently participate in any other programs or activities?

Examples: Sports, Avid, Boys and Girls Club, Religious Activities, etc.

8a. 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?

9. Do you foresee any conflicts with the dates of the program?

Breakthrough Miami is an 8-year academic enrichment program running for 6 weeks in the Summer (Monday through Friday) and 2 Saturdays a month during the School Year.

9a. Please explain conflicts/concerns:

10. 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:

None	IEP	504
Accommodation plan	RSP	Other

If applicable (i.e. speech therapy, extra tutoring, medication, any accomodations, IEP, 504 Accomodation plans, RSP, etc.)

11. Please describe educational support:

13. Please upload a student photo (optional):

Family Section: This section of the application should ONLY BE COMPLETED BY A PARENT / GUARDIAN. Breakthrough Miami 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. Why would you like your student to be part of Breakthrough?

2. What do you love about your student? What would you like us to know about them?

Student School Information

1. Name of student's current school:

If you selected "Other/Not Listed" please enter the School Name here:

2. Will the student be attending the same school next year?

If you don't know you can leave this question blank.

2a. Student's new school name:

3. Please list the name of the school counselor or registrar at your school:

Recommendation Information: Breakthrough Miami requires 2 teacher recommendations as part of the application process - one recommendation from the student's Math teacher and one from their Reading/Language Arts teacher. Please provide information for 2 teachers who would be willing to provide a recommendation for your student. We will contact these teachers directly via email. NOTE: If you need time to gather this information, you can save this application and resume it at a later time. You must remember your login email and password to be able to do this. We recommend writing this down and saving for reference.

Teacher 1

1. Recommender's Name:

If this name is missing, incorrect or misspelled, please correct under the student section on page 3 of this form.

1a. Recommender's Email:

Teacher 2

2. Recommender's Name:

f this name is missing, incorrect or misspelled, please correct under the student section on page 3 of this form.

2a. Recommender's Email:

Breakthrough Expectations

Breakthrough Miami is an academic program that requires an eight-year commitment. We expect our students to participate fully in all summer and school year programs throughout their middle and high school years. Breakthrough Miami expects 100% of its students to graduate from high school and enter college, university, or a post-secondary educational opportunity.

By checking the box below, you are acknowledging that you understand the expectations Breakthrough Miami has for its students and families accepted into its program and that you agree to turn in a completed all Supplemental Documents required.

I understand the expectations of Breakthrough Miami.

Site Assignment

Based on your Zip Code you will be considered for:

I would like to be considered for a different site

I would rather be considered for:

Please provide a reason for why you would like to apply to a different site than the one assigned:

Supplemental Documents Uploading

The Breakthrough Miami application requires Supplemental Documents to be included with this online application (see page 1 for complete details). These documents can be uploaded to this online application or delivered to the Breakthrough Miami site you are applying to. It is suggested you gather these documents prior to application submission so they are ready to be included. This application can be saved and resumed at a later time if need be.

The Supplemental Documents include: 1) Photograph of the Applicant 2) Most Recent FSA/Standardized Test Scores 3) Student Transcripts for Current & Previous School Years 4) Signed Mutual Exchange of Information Form.

1. Photograph of the Applicant:

2a. Transcripts - this year's:

2b. Transcripts - last year's:

3. Standardized Test Scores:

4. Mutual Exchange of Information Form:

6. Most recent FSA Scores

7. 2nd Grade SAT scores

It may take time for the application to process, please hit Submit only once. Thanks!

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