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Summer 2021 Breakthrough Instructional Coach Information
Thank you for your interest in Breakthrough! Whether this is your first summer coaching with us or your tenth, please take a moment to complete this brief form. Having accurate information for our team of instructional coaches helps us better evaluate our programs and their impact on students and teachers.  

Please ONLY complete this form if you have accepted an offer to coach at Breakthrough this summer and were directed to do so by a Breakthrough director. 

You may save and come back to your work by selecting “Save my progress and resume later” at the top or bottom of any page.

You may be contacted by phone or email. To avoid missing critical communication, please add to your safe-senders list. If you have questions about the process please email If you have specific questions about your site, please contact your director. 

Personal Information


The racial categories included reflect a social definition of race recognized in this country and are not an attempt to define race biologically, anthropologically, or genetically.

Phone / Email


Education History


Please convert GPA to a 4.0 scale and list your, cumulative college GPA.


Please convert GPA to a 4.0 scale.

We encourage you to save your work periodically by selecting the “Save my progress and resume later” link below.


Current Employer

Please use CTRL to select multiple options

Previous Breakthrough Experience


Disclosure of Misconduct


Select Breakthrough City
Please select the Breakthrough site at which you are coaching.

If you notice that a participating site listed on the instructional coach site directory is not listed here, they have filled all of their positions.

Thank you for taking the time to complete this form. Upon successful submission, you will be redirected to a confirmation message. Please contact your Breakthrough director with any questions about your position or the program. 

We encourage you to save your work periodically by selecting the “Save my progress and resume later” link below.