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BTSV Student Application

Application Deadline: February 21, 2025

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

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

1) Online application

Student Section (to be completed by the student)
Family Section (to be completed by the parent/guardian)
Two teacher recommendations (OR one teacher and one educator for FMSD students)
Additional paperwork to be uploaded, emailed, mailed or dropped off before the deadline

Once all application materials are received, our team will review all information carefully, confidentially, and holistically.

Breakthrough Silicon Valley is committed to making an impact in the community of Silicon Valley and changing not just the lives of our students, but also their families and the greater community. Every year we are limited to accepting 120 of the most motivated students and committed families from the Franklin-McKinley School District and San Jose Unified School District (max of 60 students from each district).

In selecting students we look for a well-written application that reflects a desire to learn, work hard, and grow, as well as a strong academic record. Our selection committee also considers standardized test scores and teacher recommendations in order to assess our ability to serve the student's academic needs. ALL accepted students must also demonstrate a need for a tuition-free program.

Students must be current 6th graders attending school in either Franklin-McKinley School District or San Jose Unified School District to be eligible to apply.

Breakthrough is committed to selecting a class of students who approximate the ethnic, racial, religious and cultural diversity of our city. Breakthrough accepts students regardless of race, creed or color; we are committed to selecting a diverse group of students who benefit from the program.

Applications Will be Reviewed by Breakthrough Staff on a Rolling Basis starting October 2024

Breakthrough Site Information:

Breakthrough Silicon Valley @ Herbert Hoover Middle School

1635 Park Ave, San Jose, CA 96126

admissions@breakthroughsv.org

408-634-3943

Breakthrough Silicon Valley @ Franklin McKinley School District

1702 McLaughlin Ave, San Jose, CA 95122

admissions@breakthroughsv.org

408-634-3943

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

What is your current school district?

What is your current school within FMSD?

What is your current school within SJUSD?

Other School:

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:

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	Turkish
Urdu	Vietnamese	Wu	Language Not Listed

Breakthrough History

Why are you applying to Breakthrough? (select all that apply)

I am motivated to go to collegeMy parents want me to joinI want to explore the fun student activitiesI am interested in gaining skills that will help me get into college

How did you hear about Breakthrough?

Breakthrough presentationBreakthrough staff memberBreakthrough studentBreakthrough Tabling EventCafecito (coffee with the principal) CORAL My Extended Family (ex. Cousin, aunt, uncle)My Immediate Family (ex. Dad, mom, brother, sister) Parent Ambassador (parent from Breakthrough) TeacherOther

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.

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 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 Answer #1

Your answer is required in order to submit.

2. Describe a time when you accomplished something, even though it was very difficult. How did you accomplish this despite the difficulties?

Student Short Response Answer #2

Your answer is required in order to submit.

3. During the Breakthrough summer program students are sometimes required to complete homework. Can you tell us how you will manage this commitment? Why do you think this is important for learning?

Student Short Response Answer #3

Your answer is required in order to submit.

This year, instead of an essay, we will be asking you to share a little bit about you if you are selected for an interview. Keep in mind that we are looking to see your best work using your creative skills.

We will give you three prompts/questions from which you will choose ONE. You will then have one week to create one of the following:

1) Prepare a 2 minute presentation

3) Prepare an essay for us to read

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. Affiliate Student Essay Selection #1

Your answer is required in order to submit.

2. Affiliate Student Essay Selection #2

Your answer is required in order to submit.

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

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.

Arabic	Bengali	Cantonese/Yue	Creole
English	French	German	Hindi
Hmong	Italian	Japanese	Javanese
Korean	Malay	Mandarin/Chinese	Marathi
Portuguese	Punjabi	Russian	Spanish
Tamil	Telugu	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.

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	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.

Breakthrough History

How did you hear about Breakthrough?

Why is your student applying to Breakthrough? (select all that apply)

My student is very excited about going to collegeI want my student to join the program I want my student to explore the fun student activitiesI want my student to gain skills that will help them get into college

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 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.

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.

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:

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:

During School Year in the evenings (6:00 pm)?During Summers?I do not want my child to travel alone on public transit.Check all that apply.

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:

Breakthrough is a rigorous 7-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.

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. Tell us why YOU, as the parent(s)/guardian(s) want to be part of the Breakthrough community and why you think it is important for your child to attend a 4-year college or university?

Parent Short Response Answer #1

Your answer is required in order to submit.

2. Breakthrough is looking for students who are committed to themselves, their academics, and to all responsibilities. Please tell us why you think your child is a dedicated and committed student. Please share any examples to support your ideas.

Parent Short Response Answer #2

Your answer is required in order to submit.

3. Please share your own educational journey with us. What obstacles, if any, did you experience, that prevented you from pursuing higher education or a college degree?

Parent Short Response Answer #3

Your answer is required in order to submit.

Student School Information

Will the student be attending the same school next year?

Student's new school name (If not attending the same school):

Please list the school counselor or registrar at your student's school:

Recommendation Information

Breakthrough Silicon Valley requires two recommendations as part of the application process. If your child attends Franklin McKinley School District, the two recommenders can either be two teachers OR one teacher and one educator (ex: school counselor, principal). If your child attends San Jose Unified School District, the two recommenders must be ONE math teacher plus ONE language arts teacher. Please provide the names and email address and we will contact these teachers directly via email.

Students of SJUSD - Please provide names of two teachers - ONE Math and ONE Language Arts, who will provide your recommendations.

Students of FMSD - Please provide the names of two recommenders. One must be a teacher. The second one can be a teacher or an educator (ex: school counselor, principal, etc)

Recommender 1

1. Recommender's Name:

If this name is incorrect or mispelled, please correct under the student section on page 4 of this form.

Recommender 1:

Please provide the teacher's full name.

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 4 of this form.

Recommender 2:

Please provide the teacher's full name.

2a. Recommender's Email:

Additional Paperwork

To complete your application, please submit a copy of the student's 6th grade report card no later than February 18, 2022.

SJUSD: Copy of 6th grade Semester 1 Final Grades

FMSD: Copy of 6th grade Quarter/Trimester 1 or 2 grades

Please select your preference for sharing these documents:

6th Grade Report Card

Please email the report card and scores to admissions@breakthroughsv.org.

Please mail or drop off these documents at one of the Breakthrough offices. For SJUSD Students drop off at Breakthrough SV Office @ Herbert Hoover Middle School - 1635 Park Ave, San Jose, CA 96126. For FMSD students, drop off at Breakthrough SV Office @ Bridges Academy - 1702 McLaughlin Ave, San Jose, CA 95122.

Breakthrough Interview

If your family's application meets our application standards, we will invite you and your child to an interview. This interview consists of Breakthrough interviewing both the student and parent/guardians(s) applying to the program. If selected to interview with Breakthrough you will be notified of your appointment two weeks prior to the interview. Interview notification will be communicated through the email account you provided on the application.

Please check your preference for an interview appointment. If multiple options work you may select more than one:

Monday - MorningMonday - AfternoonMonday - EveningTuesday - MorningTuesday - AfternoonTuesday - EveningWednesday - MorningWednesday - AfternoonWednesday - EveningThursday - MorningThursday - AfternoonThursday - EveningFriday - MorningFriday - AfternoonFriday - Evening

Please select your preferred language for the interview:

If you selected "other" for preferred interview language, please specify your preference:

Breakthrough Expectations

Over the course of our seven year program, Breakthrough works in partnership with each family in order to fully support and prepare our students for success in four-year universities. A typical Breakthrough family commits to the following:

Students attend the seven-week academic program during the summer of 2025, 2026, 2027
Students attend the after-school program once a week during 7th grade and 8th grade years
Parents attend all parent workshops, meetings, and conferences throughout the seven- year program.
Once in high school, students/families participate in the high school program through monthly workshops for both students and parents and individual conferences
Students and families maintain regular communication with Breakthrough staff.
Students attend 1-1 meetings with their advisor every month or every other month

By checking the box below, I acknowledge that I understand the program is a seven-year commitment and that we are excited to participate and receive the necessary support to ensure our child enrolls in a four-year university after high school.

Please confirm your commitment by checking the box below.

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

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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