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Student and Family Program Application (Spanish)

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 Medina, our 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 2 teacher 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

If more than one, choose the option that was most influential in applying for Breakthrough
Names of family members, teachers, etc.
School Information
ID number issued to you by the school or district.
Affiliate-Specific Instructions
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.
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.

Por favor complete las siguientes preguntas.
Parent / Guardian Information
First Name:
Last Name:
Gender:
Gender Specify:
Birth Country:
Home Address Street:
Home Address City:
Home Address State:
Home Address Zip Code:
My address is the same as the student's:
Email Address:
Home Phone:
Cell Phone:
Work Phone:
Preferred means of contact:
Please select the best day(s) to contact you:
Please select the best time(s) to contact you:

Historial de empleo (Employment History)

Employment status:
Employer name:

Historia de la Educacion (Education History)

Does your student qualify as a first-generation college student (i.e. neither parent has a 4-year degree from the US)? 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.
Highest level of education completed:
Country of Bachelor's degree

Idiona(s) del Hogar (Home Language(s))

What language do you primarily speak at home?
Is there a secondary language you speak at home?
What secondary language do you speak at home?
Are there any other language(s) you speak at home?
What additional language(s) do you speak at home? Select all that apply.
How comfortable are you with English?
Would you need documents and communication to be translated for you?

Detalles de la Relacion (Relationship Details)

Is the student being raised in a single parent household?
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? 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 on other adult(s): Ex: Name, relationship, contact information, etc.
How much of the time does your student live with you?
Does the 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:
I would like to enter information for a second Parent/Guardian:
Información de Contacto del Otro Padre/ Tutor (Parent / Guardian #2 Contact Information
Does Parent/Guardian #2 live in the same household as Parent/Guardian #1?
I am only comfortable providing basic contact information on behalf of 'Parent / Guardian #2'.
First Name:
Last Name:
Gender:
Gender Specify:
Birth Country:
Home Address Street:
Home Address City:
Home Address State:
Home Address Zip Code:
Home Phone:

Detalles de la Relacion (Relationship Details)

What is their relationship to the student?
How much of the time does the student live with them?
Cell Phone:
Work Phone:
Email Address:
Preferred means of contact:
Please select the best day(s) to contact them:
Please select the best time(s) to contact them:

Historial de Empleo (Employment History)

Employment status:
Employer name:

Historia de la Educacion (Education History)

Their highest level of education completed:
Country of Bachelor's degree

Idiona(s) del Hogar (Home Language(s))

What language is primarily spoken in their home?
Is there a secondary language spoken at their home?
What secondary language do they speak at their home?
Are there any other language(s) they speak at home?
What additional language(s) do they speak at home? Select all that apply.
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 will review all information carefully, confidentially, and holistically.

Historal de Breakthrough (Breakthrough History)

How did you hear about Breakthrough? Select all that apply.
Other - please explain:
Please provide details on how you heard about Breakthrough: Names of family members, teachers, etc.
Do you have any other children or relatives in the program?
What is their relationship to the student applicant?
Please provide details of the Breakthrough student(s): name(s), relationship type(s), Breakthrough site(s), and their current grade level(s):
Antecedentes de Familia (Family Background)
Is your monthly income fixed or flexible?
What is your ANNUAL pre-tax household 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): 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).
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.

Antecedentes del Estudiante (Student Background)
 
Does your student qualify for Free or Reduced Price Lunch? 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).
Is your student Hispanic or Latinx?

Which of the following choices describe your student's race? Select all that apply.
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: Check all that apply.
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/services your student has or is currently receiving. Please select all that apply. If applicable (i.e. speech therapy, extra tutoring, medication, any accomodations, IEP, 504 Accomodation plans, RSP, etc.)
Please describe educational support/ services:
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.

Affiliate-Specific Instructions
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.
Preguntas de Respuesta Corta : Ayuudenos a concocer a su estudiante respondiendo a las preguntas a continuacion.  Por favor escriba al menos dos oraciones completas. (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. ¿En qué áreas le gustaría que su hijo creciera al participar en este programa? 

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.  ¿Cómo piensa apoyar el crecimiento y el desarrollo de su hijo a través de este programa?

How do you plan to support your child's growth and development through this program? Your answer is required in order to submit.
Información de la escuela del estudiante (Student School Information)
Name of student's current school:
Other School:
Will the student be attending the same school next year?
Student's new school name:
Please list the school counselor or registrar at your student's school:
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 teachers directly via email. 
Recomendante 1
If this name is incorrect or mispelled, please correct under the student section on page 3 of this form.
1a. Recommender's Email:
Recomendante 2
If this name is incorrect or mispelled, please correct under the student section on page 3 of this form.
2a. Recommender's Email:
Breakthrough Expectations
Expectativas de Breakthrough

Como estudiante de Breakthrough Providence, haré lo siguiente:
  • asumir la responsabilidad de mi participación en el programa.
  • Establecer altos estándares académicos y perseguir activamente mis metas.
  • buscar ayuda y comunicarse abiertamente con los maestros y el personal de BTP.
  • Respetar a los estudiantes, maestros y personal del programa, a través de mis acciones y palabras.
Como padre/guardián de Breakthrough, haré lo siguiente:
  • apoyar, mantener y reforzar el compromiso de dos años de mi hijo con BTP.
  • asegurarme de que mi hijo/a tenga una participación constante en BTP durante todo el verano y el año escolar.
  • participar activamente en la experiencia de mi hijo/a. Esto significa participando en actividades familiares incluyendo conferencias de estudiantes y familias y eventos de BTP como la noche de bienvenida, la orientación, y la noche de opciones de la escuela secundaria.
Al marcar la casilla a continuación, usted reconoce que comprende las expectativas que Breakthrough tiene para sus estudiantes y familias aceptadas en su programa.
  • By checking the box below, you are acknowledging that you understand the expectations Breakthrough has for its students and families accepted into its program.

Please confirm your commitment by checking the box below. 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 the get the ID from URL. Connector won't work until this is done.
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