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💛 WELCOME TO BREAKTHROUGH HOUSTON 💛

This application is your first step into a community that will cheer for you, challenge you, and walk with you from middle school to college graduation.

Breakthrough Scholars are curious, hardworking, and ready to grow—not because they have everything figured out, but because they believe in what’s possible for their future.

Here, you’ll explore new ideas, build friendships with students from across Houston, and discover what you’re capable of when people truly invest in you. Take your time. Be yourself. We’re excited to learn your story—and even more excited to build what comes next with you.

Application Guidelines:

This application will take about 15 minutes to complete. Please be sure to submit all responses in English.

When you’re ready to submit, make sure you have:

Your parent/guardian’s contact information
The name and email address of a teacher who can provide a letter of recommendation
A copy of your latest report card (a picture or PDF)
A copy of your latest STAAR scores accessible through this online portal. You can reach out to your current school's registrar to find your access code.

Application Timeline:

Priority 1 Deadline: January 15
- Decisions Released: March 1
Priority 2 Deadline: March 15
- Decisions Released: May 1
Regular Decision Deadline: May 1
- Decisions Released: Rolling

Take your time. Answer honestly. We can’t wait to get to know you. 💛

Priority 1 Deadline: January 15, 2026

Priority 2 Deadline: March 15, 2026

Regular Decision Deadline: May 1, 2026

EMAIL PROGRAMS@BREAKTHROUGHHOUSTON.ORG WITH ANY QUESTIONS.

Student Section:

This part is all about you — your experiences, your interests, and what you think.
Please complete this section on your own.

If you get stuck or need help understanding a question, no worries — just ask a trusted adult to support you. We’re excited to learn more about you! 💛

STUDENT INFORMATION

First Name

Middle Name:

Last Name:

Preferred Name/ Nickname:

Student Email Address:

Student Cell Phone:

If you do not have a cell phone number, write 000-000-0000

Birth Date:

Birth Country:

Gender:

Gender Specify:

Home Phone:

Home Address Street Name:

Example: 3100 Timmons Lane APT 360

City:

State:

Zip Code:

STUDENT SCHOOL INFORMATION

Name of student's current school. Please select 'School Not Listed', if your school is not in the list:

If 'School Not Listed', type School Name here:

Will the student be attending the same school next year?

Student's new school name:

Current Grade for 2025 - 2026:

How difficult is your current school work?

Student School ID Number:

ID number issued to you by the school or district.

STUDENT LANGUAGE(S)

What language do you speak most of the time, at home?

Do you speak any other language(s) at home?

What is the second most common language you speak at home?

Are there any other language(s) you speak at home?

Select any other language(s) you speak at home:

Arabic	Bengali	Cantonese/Yue	Creole
English	French	German	Hindi
Hmong	Italian	Japanese	Javanese
Karen	Korean	Language Not Listed	Malay
Mandarin/Chinese	Marathi	Pashto	Portuguese
Punjabi	Russian	Spanish	Tamil
Telugu	Turkish	Urdu	Vietnamese
Wu

Student Section:

This part is all about you — your experiences, your interests, and what you think.
Please complete this section on your own.

If you get stuck or need help understanding a question, no worries — just ask a trusted adult to support you. We’re excited to learn more about you! 💛

SITE PREFERENCE

Breakthrough Houston operates summer programming at three locations across the city. While each site offers the same high-quality experience, families are encouraged to select the location that is most accessible for consistent participation during both the summer and school year. Final site placements are made by Breakthrough based on availability and overall program fit.

First Site Preference

TEACHER RECOMMENDATION

As part of your application, one teacher will need to share a recommendation for you.
Please write the teacher’s name and their full email address so we can contact them.

Teacher's First and Last Name:

Teacher's Email Address:

Recommender 2:

Please provide the teacher's full name.

Recommender 2 Email:

Please provide full teacher email.

BREAKTHROUGH CONNECTION

This year, we’ll be recognizing those who help introduce others to Breakthrough. 🎉
When you answer the next question, please make sure you choose the real way you first heard about us. If you learned about Breakthrough from multiple places, pick the one that had the biggest impact on your decision to apply.

How did you hear about Breakthrough?

Breakthrough School PresentationBreakthrough Staff MemberBreakthrough StudentCommunity Event Family connectionTeacherOther

Other - please explain:

Please provide the first and last name of who referred you to Breakthrough:

Names of family members, teachers, etc.

Student Section:

This part is all about you — your experiences, your interests, and what you think.
Please complete this section on your own.

If you get stuck or need help understanding a question, no worries — just ask a trusted adult to support you. We’re excited to learn more about you! 💛

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 in complete sentences. We want to see YOUR best work (not ChatGPT's work). 😉 #ProTip: Copy/paste your response from a Google/Word document to ensure it has been spellchecked, proofread, and edited.

1. In 3-5 complete sentences, please answer the following questions:

Why do you want to join the Breakthrough community?
What are your big, lofty goals and dreams for yourself?
How do you hope Breakthrough helps you achieve your goals?

Student Short Response Answer #1

Your answer is required in order to submit.

Optional: Tell us about any communities you are connected to or identify with. This may include culture/ethnicity, religion/faith, or any other group that is an important part of who you are.

[Optional Supplement] Express yourself! Share something that uses your creativity! It can be anything: drawings, poetry, math equations, a rap you wrote, photos you took, or anything else that expresses you!

Family Section / Sección Familiar:

This section is meant for parents/guardians to complete. If your student is filling out the application, please pause and ask a parent/guardian to support you here. Please note, all responses should be completed in English.

Esta sección debe ser completada por los padres o tutores legales. Si su hijo/a está completando la solicitud, por favor, haga una pausa y pida a un padre o tutor legal que continúe desde aquí.

PARENT / GUARDIAN INFORMATION

What is your relationship to the student?

¿Qué relación tienes con el estudiante?

First Name:

Nombre del padre:

Last Name:

Apellido de los padres:

Gender:

Género de los padres

Gender Specify:

Birth Country:

País de nacimiento de los padres:

Home Address Street Name:

Example: 3100 Timmons Lane APT 360

City:

State:

Zip Code:

My address is the same as the student:

Parent Email Address:

Dirección de correo electrónico:

Home Phone:

Teléfono de casa:

Parent Cell Phone:

Teléfono móvil:

Work Phone:

Teléfono del trabajo

Preferred means of contact:

Medio de contacto preferido:

Employment History / Historial de empleo

Employment status:

Situación laboral:

Employer name:

Education History / Historia de la educación

Does your student qualify as a first-generation college student (i.e. Neither parent has a 4-year degree from the US)?

Highest level of education completed:

Nivel máximo de estudios completado:

Country of Bachelor's degree

País de origen de la licenciatura

Home Language(s) / Idioma(s) materno(s)

What language do you primarily speak at home?

¿Qué idioma hablas principalmente en casa?

Is there a secondary language you speak at home?

¿Hablas algún otro idioma en casa?

What secondary language do you speak at home?

Are there any other language(s) you speak at home?

¿Hablas algún otro idioma en casa?

What additional language(s) do you speak at home? Select all that apply.

Arabic	Bengali	Cantonese/Yue	Creole
English	French	German	Hindi
Hmong	Italian	Japanese	Javanese
Korean	Malay	Mandarin/Chinese	Marathi
Pashto	Portuguese	Punjabi	Russian
Spanish	Tamil	Telugu	Turkish
Urdu	Vietnamese	Wu	Language Not Listed

¿Qué otros idiomas habla en casa? Seleccione todos los que correspondan.

How comfortable are you with English?

¿Qué tan cómodo te sientes con el inglés?

Would you need documents and communication to be translated for you?

Relationship Details / Detalles de la relación

Is the student being raised in a single parent household?

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?

Are there any other adult(s) involved in the student's upbringing or living in your home that we should be in contact with?

¿Hay algún otro adulto involucrado en la crianza del estudiante o que viva en su casa con quien debamos ponernos en contacto?

Please provide details on other adult(s) / Por favor, proporcione detalles sobre el/los otro/s adulto/s:

Ex: Name, relationship, contact information, etc.

How much of the time does your student live with you?

¿Cuánto tiempo vive tu alumno contigo?

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:

Parent / Guardian #2 Contact Information

What is their relationship to the student?

¿Qué relación tienen con el estudiante?

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'.Me siento cómodo proporcionando únicamente información de contacto básica en nombre de Padre/Tutor #2.

First Name:

Nombre del padre / tutor 2:

Last Name:

Apellido del padre / tutor 2:

Gender:

Padre / tutor 2 género

Gender Specify:

Birth Country:

País de nacimiento del padre/tutor 2

Home Address Street:

Dirección del domicilio del padre/tutor 2:

Home Address City:

Padre/Tutor 2 ciudad

Home Address State:

Padre/Tutor 2 estado

Home Address Zip Code:

Código postal del padre/tutor 2

Home Phone:

Teléfono de casa del padre/tutor 2:

Relationship Details / Detalles de la relación

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

¿Cuánto tiempo vive el estudiante con ellos?

Cell Phone:

Teléfono móvil:

Work Phone:

Teléfono del trabajo:

Email Address:

Dirección de correo electrónico:

Preferred means of contact:

Medio de contacto preferido:

Employment History / Historial de empleo

Employment status:

Situación laboral:

Employer name:

Education History / Historia de la educación

Their highest level of education completed:

Su nivel máximo de estudios completado:

Country of Bachelor's degree

País de origen de la licenciatura

Home Language

What language is primarily spoken in their home?

¿Qué idioma se habla principalmente en su hogar?

Is there a secondary language spoken at their home?

¿Se habla algún otro idioma en su casa?

What secondary language do they speak at their home?

¿Qué segundo idioma hablan en casa?

Are there any other language(s) they speak at home?

¿Hablan algún otro idioma en casa?

What additional language(s) do they speak at home? Select all that apply.

Arabic	Bengali	Cantonese/Yue	Creole
English	French	German	Hindi
Hmong	Italian	Japanese	Javanese
Karen	Korean	Malay	Mandarin/Chinese
Marathi	Pashto	Portuguese	Punjabi
Russian	Spanish	Tamil	Telugu
Turkish	Urdu	Vietnamese	Wu
Language Not Listed

¿Qué otros idiomas hablan en casa? Seleccione todos los que correspondan.

How comfortable are they with English?

¿Qué tan cómodos se sienten con el inglés?

Would they need documents and communication to be translated?

¿Necesitarían que se tradujeran los documentos y las comunicaciones?

Family Section / Sección Familiar:

This section is meant for parents/guardians to complete. If your student is filling out the application, please pause and ask a parent/guardian to continue from here.

Esta sección debe ser completada por los padres o tutores legales. Si su hijo/a está completando la solicitud, por favor, haga una pausa y pida a un padre o tutor legal que continúe desde aquí.

BREAKTHROUGH CONNECTION

How did you hear about Breakthrough?

Breakthrough presentationBreakthrough staff memberFamily connectionTeacherBreakthrough studentOtherSelect 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):

Family Section / Sección Familiar:

This section is meant for parents/guardians to complete. If your student is filling out the application, please pause and ask a parent/guardian to continue from here.

Esta sección debe ser completada por los padres o tutores legales. Si su hijo/a está completando la solicitud, por favor, haga una pausa y pida a un padre o tutor legal que continúe desde aquí.

HOUSEHOLD FINANCIAL INFORMATION

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?

Has anything happened in the last year that has impacted the accuracy of the information provided on your current financial situation?

STUDENT BACKGROUND

Does your student qualify for Free or Reduced Price Lunch?

Is your student Hispanic or Latinx?

Which of the following choices describe your student's race? Select all that apply.

Alaska Native American IndianAsian or Asian AmericanBlack or African AmericanMiddle Eastern or North AfricanMultiracialNative HawaiianPacific IslanderWhite Other Race, not listedDecline to State

Please specify student's country/ies of origin:

Hold down the Ctrl button to choose more than one.

How will your student get to/from Breakthrough?

Other transport:

Does your student currently participate in any other programs or activities? Examples: Sports, AVID, Boys and Girls Club, Religious Activities, etc.

Does your student have any other commitments this summer? If so, how might they affect their ability to fully participate in the program?

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

Please explain conflicts/concerns:

To make sure your student receives the right support and encouragement in Breakthrough, please tell us about any educational services or supports they receive now or have received in the past. Please select all that apply.

None	English Language Learner	IEP - Individualized Education Program
504	Accommodation Plan	RSP - Resource Specialist Program
Other

Please describe educational support/ services:

Breakthrough walks with students for 10 years, and we know students thrive when families are part of the journey too. In your own words, how will you help your student follow through and stay committed to the program over time?

Breakthrough acompaña a los estudiantes durante 10 años, y sabemos que prosperan cuando las familias también forman parte del proceso. En sus propias palabras, ¿cómo ayudará a su hijo/a a perseverar y mantenerse comprometido/a con el programa a lo largo del tiempo?

Family Section / Sección Familiar:

This section is meant for parents/guardians to complete. If your student is filling out the application, please pause and ask a parent/guardian to continue from here. Reminder: All answers should be submitted in English.

Esta sección debe ser completada por los padres o tutores legales. Si su hijo/a está completando la solicitud, por favor, haga una pausa y pida a un padre o tutor legal que continúe desde aquí.

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 3–5 sentences, please answer the following questions:

Why you would like your student to be part of Breakthrough?
What do you love most about your student?
What should we know about who they are as a learner, family member, and community member?

Parent Short Response Answer #1

2. Optional: Tell us about any communities your student is connected to or identifies with. This may include culture/ethnicity, religion/faith, or any other group that is an important part of who they are.

Cuéntanos sobre las comunidades con las que tu estudiante tiene alguna conexión o se identifica. Esto puede incluir cultura/etnia, religión/creencia o cualquier otro grupo que sea una parte importante de su identidad.

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 recommenders directly via email.

1a. Recommender's Email:

Recommender 2

2. Recommender's Name:

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

2a. Recommender's Email:

SUPPORTING DOCUMENTS

To complete your application, please submit a copy of the student's most recent report card or bring physical copies to your interview.

Please select your preference for sharing these documents:

Recent Photo of Student

Por favor, suba una foto del estudiante (opcional):

Most Recent Report Card

Most Recent STAAR Scores

If these documents are not uploaded at the time of submission, a copy will be requested during your interview.

BREAKTHROUGH PARTNERSHIP AGREEMENT

By checking the box below, you are affirming our shared commitment to partner together in supporting your student’s growth and success.

Our Family Partnership:

We stay connected as a team—families check email/Remind for monthly communication from BTH and encourage your student to attend programming consistently, knowing that relationships and learning grow over time.

We communicate with care—reach out to BTH; we are here to listen, support, and work together. If something changes at home or school that may affect your student, please let us know so we can respond with care. In return, BTH will communicate with you regularly about your student's progress and goals.

We invite you to join us— families are invited to attend family events, workshops, and celebrations when possible. Your presence strengthens our community!

We invest in the long-term journey—Breakthrough is a joyful, 10-year scholarship that grows alongside your student and family from middle school through college.

I understand and agree to Breakthrough Houston's shared commitments.

Affiliate Application Record Type ID

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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!

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