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Breakthrough San Francisco Student Application

Application Deadline: Friday, February 28, 2025

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

Breakthrough accepts students regardless of race, creed, or color and is committed to selecting a class of students that represents the diversity of San Francisco. Please note that applicants must meet at least three of our five need criteria: potential first-generation college student; eligible for free- or reduced-price lunch; speaks a language other than English at home; lives in a single-parent household; and/or attends an under-resourced school.

Selection Timeline for Summer 2025:

Online Application and Parent/Guardian Packet Due Date: Fri, February 28, 2025

Applications Reviewed by Breakthrough Staff: March 12-March 19, 2025

Interview Notifications: Mon, March 24, 2025

Interview Days; Sat, April 5 OR Sat, April 12, 2025

Decision Letters E-Mailed: Fri, April 25, 2025

Breakthrough San Francisco is a year-round academic enrichment program for motivated San Francisco students with limited educational opportunities. Students apply as fourth graders and make an eight-year commitment, with the goal of attending a best-fit four-year college. All programming is tuition-free and takes place at San Francisco Day School (350 Masonic Ave, San Francisco, CA 94118).

To learn more, please visit our website at www.breakthroughsf.org or email us at apply@breakthroughsf.org.

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. Please note, your information will be kept confidential and will not be shared with outside parties. 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:

Home Phone:

Cell Phone:

Gender:

Gender Specify:

Birth Date:

Birth Country:

Home Address Street:

Home Address City:

Home Address State:

Home Address Zip Code:

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:

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

Teacher Recommendation

Breakthrough requires one recommendation as part of the application process. Please list the teacher who will provide your recommendation. Your parent / guardian will be asked to provide their email address in the parent section of the application.

Recommender:

Please provide the teacher's full name.

Breakthrough History

How did you hear about Breakthrough?

Breakthrough presentationBreakthrough staff memberFamily connectionTeacherBreakthrough studentOtherIf more than one, choose the option that was most influential in applying for Breakthrough

Other - please explain:

Please provide details on how you heard about Breakthrough:

Names of family members, teachers, etc.

School Information

Current Grade:

How difficult is your current school work?

Your student School ID number:

ID number issued to you by the school or district.

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. Please be sure that the answers are your own, not from anyone/anything else. Please note, your information will be kept confidential and will not be shared with outside parties. If you have any questions as you complete this portion of the application, please reach out to an adult.

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 in AT LEAST 2 sentences. We want to see your best work! You may copy/paste from a Word document if you like.

1. Describe a time when you did something difficult or outside your “comfort zone.” What was the outcome? What did you learn from the experience?

Student Short Response #1 Answer

Your answer is required in order to submit.

2. What are your favorite things to do outside of school (hobbies, special interests, etc.)? Why do you enjoy them?

Student Short Response #2 Answer

Your answer is required in order to submit.

3. Breakthrough is a long-term commitment. See program description for a full explanation of the commitment. 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?

Student Short Response #3 Answer

Your answer is required in order to submit.

Essay: Please answer the questions below using AT LEAST 8-10 sentences. We want to see your best work! You may copy/paste from a Word document if you like.

1. Consider a community of which you are part (e.g., neighborhood, school, or church) and reflect on one challenge faced by that community. How can you help solve this challenge?

Student Essay #1 Answer

Your answer is required in order to submit.

2. 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.

Student Essay #2 Answer

Your answer is required in order to submit.

STUDENT WORK:

This activity represents YOU! Have fun and use a blank sheet of paper to tell us about yourself. Fill up the space with your creativity! You can put anything here: a collage, drawings, math equations, pictures, poetry, a rap, or whatever else shows us a little more about who you are! Upload your work below. If you have trouble uploading, email to apply@breakthroughsf.org. Be sure to include your full name and grade!

Upload Student Work here

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

Breakthrough will review all information carefully, confidentially, and holistically. Please note, your information will be kept confidential and will not be shared with outside parties.

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:

Email Address:

Home Phone:

Cell Phone:

Work Phone:

Preferred means of contact:

Please select the best day(s) to contact you:

MondayTuesdayWednesdayThursdayFridaySaturdaySunday

Please select the best time(s) to contact you:

MorningDaytimeEvening

Employment History

Employment status:

Employer name:

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

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.

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

How comfortable are you with English?

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

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?

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:

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:

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:

MondayTuesdayWednesdayThursdayFridaySaturdaySunday

Please select the best time(s) to contact them:

MorningDaytimeEvening

Employment History

Employment status:

Employer name:

Education History

Their highest level of education completed:

Country of Bachelor's degree

Home Language

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.

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

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. Please note, your information will be kept confidential and will not be shared with outside parties.

Breakthrough History

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 Background

Is your monthly income fixed or flexible?

What is your estimated ANNUAL pre-tax household income for 2024?

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?

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

Please note, your information will be kept confidential and will not be shared with outside parties.

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://www.benefits.gov/benefit/1953 (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.

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.

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:

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.

None	EL	IEP
504	Accommodation plan	RSP
Other

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

Please describe educational support/ services:

Please upload your student's final 3rd grade report card (5th Grade applicants: final 4th grade report card) below. If you have any trouble uploading, you can email directly to apply@breakthroughsf.org.

Please upload your student's most recent 4th grade report card (5th Grade applicants: most recent 5th grade report card)
below. If you have any trouble uploading, you can email directly to apply@breakthroughsf.org.

Breakthrough is a rigorous 8-year academic commitment. How will you help your student fulfill this commitment? Please explain:

Please upload a student photo (waist up, plain background and smile).

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

Please be sure that the answers are your own, not from anyone/anything else. Breakthrough will review all information carefully, confidentially, and holistically. Please note, your information will be kept confidential and will not be shared with outside parties.

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

Parent/Guardian Short Response Answer #1

Your answer is required in order to submit.

2. What goals do you have for your student? How do you see Breakthrough fitting into your student's future?

Parent/Guardian Short Response Answer #2

Your answer is required in order to submit.

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 one recommendation as part of the application process. Your student has already provided a name, please provide the email address and we will contact the recommender directly via email.

Recommender

Recommender's Name:

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

Recommender's Email:

Breakthrough Expectations

Breakthrough San Francisco students make an eight-year commitment. During the summers before fifth - eighth grade, students attend our six-week summer academic program and complete roughly one hour of homework nightly. During their fifth - eighth grade school years, students attend Breakthrough two afternoons per week for academic support. During their ninth - twelfth grade years, students attend monthly Saturday workshops. Students and families are also expected to participate in middle school, high school, and college admissions support and carefully consider the advice and suggestions of Breakthrough staff. Attendance is mandatory; we expect our students and families to plan all other commitments around Breakthrough programming over the course of their eight years with us.

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.

I understand the expectations of BreakthroughYour answer is required in order to submit.

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!

Affiliate Application Record Type ID

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.

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