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Student & Family Program Application

Rolling Admissions Deadline: May 1, 2022
Thank you for your interest in Breakthrough!  Students and parents should carefully read all of the information below. Within this application, we ask that you provide information that Breakthrough Providence can use to best serve you.
Breakthrough Providence is committed to selecting a class of students who approximate the ethnic, racial, religious and cultural diversity of our city.  Breakthrough Providence 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 2022:


Online Application and Parent / Guardian Packet Due Date: March 5, 2022

Rolling Admission now through May 1st, 2022


Applications Reviewed by Breakthrough Staff: 3/1/22 - 3/12/2022


Follow-up Calls: 3/14/22 - 3/31/22


Decision Letters Mailed: April 1, 2022




Breakthrough Providence Information:

For any questions about your application or program, contact Genevieve Medinaour Middle School Program Manager at gmedina@breakthroughprovidence.org 
or via phone: 401-528-2152.

Mailing Address: 
216 Hope Street
Providence, RI, 02906 

Miami
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 Language(s)
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
Breakthrough requires two recommendations as part of the application process.  Please list the teachers who will provide your recommendations.  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

Select all that apply
Names of family members, teachers, etc.
School Information
ID number issued to you by the school or district.
Affiliate Instruction
For all short answer and essay questions you need to populate the question(s) below AND in the Connector in order for the record in Salesforce to show the question they are answering. These instructions are for your use and will be hidden from applicants.
Short Answer Questions:  Please answer all of the questions below using at least 2 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 two-year commitment at minimum. 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.

Please complete the following questions. 
Parent / Guardian Information

Employment History

Education History

A first-generation student means BOTH parents did not complete a 4-year college or university degree (or higher). If a degree was obtained from a country other than the United States, a student qualifies as a first-generation student.

Home Language(s)

Relationship Details

Ex: Name, relationship, contact information, etc.
Parent / Guardian #2 Contact Information

Relationship Details

Employment History

Education History

Home Language

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

Select all that apply.
Names of family members, teachers, etc.
Family Background
Form 1040 is an IRS tax form used for personal federal income tax returns filed by United States residents. The form calculates the total taxable income of the taxpayer. IRS 1040 form can be found here : https://www.irs.gov/pub/irs-pdf/f1040.pdf (copy and paste into a new browser).

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
If you are unsure if your student qualifies, visit this website to calculate free or reduced price lunch status: https://reports.educateiowa.gov/ICAVES/Home/Calculator (copy and paste into a new browser).

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.)

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

Affiliate Instruction
For all short answer and/or essay questions you need to populate the question(s) below AND in the Connector in order for the record in Salesforce to show the question they are answering. These instructions are for your use and will be hidden from applicants.
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. In what areas would you like to see your child grow through participating in this program?

Your answer is required in order to submit.
2.  How do you plan to support your child's growth and development through this program?

Your answer is required in order to submit.
Student School Information
Recommendation Information: Breakthrough requires two recommendations as part of the application process. Your student has already provided names, please provide the email address and we will contact these recommenders directly via email. 

Recommender 1
If this name is incorrect or mispelled, please correct under the student section on page 3 of this form.
Recommender 2
If this name is incorrect or mispelled, please correct under the student section on page 3 of this form.
Breakthrough Expectations
As a Breakthrough Providence student, I will: 
  • take responsibility for my involvement in the program. 
  • establish high academic standards and actively pursue my goals. 
  • seek help from and communicate openly with, BTP teachers and staff. 
  • respect the students, teachers, and staff in the program, through my actions and words.
As a Breakthrough Parent/Guardian, I will: 
  • support, uphold, and reinforce my child’s two-year commitment to BTP. 
  • ensure my child has consistent participation in BTP 
  • throughout the two-year commitment (summer and school year). 
  • participate actively in my child’s experience by participating in family engagement activities, including Student/Family conferences and BTP events like Welcome back night, orientation, and High School options night.

By checking the box below, you are acknowledging that you understand the expectations Breakthrough has for its students and families accepted into its program.

Your answer is required in order to submit.
This must have a "Default Value" populated with the Application Record Type ID for each affiliate as part of launch. This is found in Setup>Object Manager>Application>Record Types>Application>then get the ID from URL. Connector won't work until this is done.
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!" Please do not hit submit a second time. Thank you for your patience!