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BREAKTHROUGH HOUSTON INTEREST FORM

About BTH: Breakthrough Houston is a tuition-free, ten-year program that supports students from middle school through college graduation. Through academic enrichment, mentoring, and long-term guidance, we help students break through barriers and reach their full potential.

For the 2026 program year, we have 135 open seats for rising 7th graders and 55 open seats for rising 8th graders across our program sites. Completing this form is the first step in the application process. After you submit it, our team will follow up with a link to the application and an invitation to join our upcoming application workshops.
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Acerca de BTH: Breakthrough Houston es un programa gratuito de diez años que apoya a estudiantes desde la secundaria hasta la graduación universitaria. Mediante enriquecimiento académico, mentoría y orientación a largo plazo, ayudamos a los estudiantes a superar barreras y alcanzar su máximo potencial.

Para el año académico 2026, contamos con 135 plazas disponibles para estudiantes que cursan 7.º grado y 55 plazas disponibles para estudiantes que cursan 8.º grado en todas nuestras sedes. Completar este formulario es el primer paso del proceso de solicitud. Después de enviarlo, nuestro equipo le enviará un enlace a la solicitud y una invitación para participar en nuestros próximos talleres de solicitud.

EMAIL PROGRAMS@BREAKTHROUGHHOUSTON.ORG WITH ANY QUESTIONS.

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:

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 Level:

How difficult is your current school work?

Student School ID Number:

ID number issued to you by the school or district.

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

Do you have a unit or apartment number?

YesNo

Unit/Apt. #

City:

State:

Zip Code:

My address is the same as the student:

Parent Email Address:

Dirección de correo electrónico:

Parent Cell Phone:

Teléfono móvil:

Work Phone:

Teléfono del trabajo