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New Student Application 2027

Application Deadline: March 12

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

At Breakthrough Cincinnati, we believe in the power of young people. Our unique “students teaching students” model will transform your child’s summer learning experiences from boredom to brilliance. The only program of its kind in our region, Breakthrough Cincinnati provides an academically enriching and fun community for rising sixth through ninth graders. Your child will develop the academic and leadership skills necessary for success in college and beyond. We are excited to get to know your child and your family. Breakthrough Cincinnati provides rigorous multi-week, four-year, college-preparatory summer learning experiences tuition-free, for high-need and high-potential middle school students and inspires and trains college students as the next generation of teachers. The summer programs take place at two local sites. Each day, Monday-Friday, 9-4pm, students take courses in English, math, history and science in small classes of eight to ten students. In the afternoon, students attend academic electives, life skills and leadership workshops, and participate in additional experiences in athletics or the arts. Students also experience community service, career exploration and outdoor experiences. During the school year, BTC remains invested in the academic success of our students. Students should engage at least three times in school year programming that supports academic, social, and professional growth. We have college and career focused Super Saturdays as well as monthly leadership and social events. Breakthrough Cincinnati students share a love of learning and want to go to college. They strive to do their best and are always open to new ideas and experiences. BTC students work hard, want to develop leadership skills, and have fun in the process. Their families are engaged in the learning process and have aspirations for their child’s success. Transportation can be provided for most students. BTC contracts with a third party transportation provider using a hub system. If your child is selected for the program, we will communicate extensively with you in the weeks prior to the program’s start date to plan your student’s transportation. Breakthrough is committed to selecting a cohort of students who approximate the makeup of our city. Our program welcomes all members of our community, and we celebrate all identities. Breakthrough wants to support students who are eager for a challenge and can benefit from the enrichment program. BTC aims to create a safe and optimum learning environment to prepare students for a lifetime of success. As a safe space, BTC wants all community members to support the values and goals of the program by using respectful language and behavior that is indicative of the community we wish to be a part of. Application Requests: Student Short responses (student interests) Family responses (background, financial info, transportation needs) Student Records (report card and test scores) Teacher Recommendation Post-Application Request: Family interview Items needed to help complete the application: Parent or non-school email (checked regularly) (put @breakthroughicincinnati.org on safe-list) A computer is better than a phone Pre-written responses (from questions posted in the Application Guide)

2025 family taxable income Teacher Recommender email address Report Card & ELA/MA Standards-based Test Scores TIME: Estimated completion time is 30 minutes

Selection Timeline for Summer Program

Online Application Due Date: March 12

Follow-Up Items Due: March 19

Breakthrough Student-Family Interviews: March 21 - April 18

Regular Decision Letters sent after: April 14

Student & Family Orientations: April 21-25

Summer Program Dates: June 28-July 30

Breakthrough Site Information: www.breakthroughcincinnati.org

Breakthrough Cincinnati has two sites. Students are assigned to sites based on school enrollment and geographic needs.

Breakthrough Cincinnati @ Cincinnati Country Day School

6905 Given Road, Cincinnati, Ohio 45243

Breakthrough Cincinnati @ University of Cincinnati

2600 Clifton Ave. Cincinnati OH 45221

Questions? Email:

applystudent@breakthroughcincinnati.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. 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:

Please use a personal (non-school) email address, since you may not get our emails if you use a school address! If your student doesn't have an email, please provide the primary parent's email address.

Student Email Address:

Home Phone:

Student Cell Phone:

Sex:

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

Teacher or Other Recommenders

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 1:

Please provide the teacher's full name.

Recommender 2:

Please provide the teacher's full name.

Breakthrough History

How did you hear about Breakthrough?

Breakthrough presentationBreakthrough staff memberBreakthrough studentFamily connectionSocial MediaTeacherWebsite/Internet SearchOtherIf 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:

Name of student's current school:

School Name, if "Other"

Will the student be attending the same school next year?

Student's new school name:

How difficult is your current school work?

Your student School ID number:

ID number issued to you by the school or district.

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 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 college readiness program. Why is going to college important to you?

Student Short Response #1

Your answer is required in order to submit.

2. What does it mean to be a leader? Describe a time you were a leader.

Student Short Response #2

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. What topic are you most interested in? Tell us everything you know about it in 250 words.

Student Essay #1

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:

Is your home address within Cincinnati City Limits?

In which neighborhood do you live?

In which County do you live?

Primary Parent/Guardian Email Address:

Home Phone:

Primary Parent/Guardian 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?

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:

Relationship Details

What is their relationship to the student?

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

Cell Phone:

Secondary Email Address:

Home Phone:

Work Phone:

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(s)

What language is primarily spoken in 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?

Breakthrough presentationBreakthrough staff memberBreakthrough studentFamily connectionSocial MediaTeacherWebsite/ Internet SearchOtherSelect 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?

If they are a current student at Breakthrough, which campus?

Please provide details of the Breakthrough student(s): name(s), relationship type(s), Breakthrough site(s), and their current grade level(s):

Family Background

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 OLDER than 18 years of age?

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.

Breakthrough operates at 2 locations:

Cincinnati Country Day School (6905 Given Rd. 45243)

University of Cincinnati (2600 Clifton Ave. 45219)

Students are assigned to locations based on several factors. Busing may be provided with the support of our external transportation vendor, who primarily uses a Neighborhood Hub pick-up system. Consider your site preference and transportation choice based on your home address to the nearest BTC location. Note: In some circumstances, busing may not be the best option, and you may not be placed at the site closest to your home.

Which site is closest to your home address? (Note, this does not mean you will attend that site.)

Cincinnati Country Day School (6905 Given Rd. 45243)University of Cincinnati (2600 Clifton Ave. 45219)

How would you like 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 SUMMERTIME commitment(s). How many hours per week does your student dedicate to each activity and how flexible are these commitments?

Summer 2027 Programming runs from June 28-July 30 (Monday through Friday);

9:00-4:00.

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 a student photo (optional):

I consent to learning about college opportunities from local universities (eg., UC) and/or Breakthrough in the future.

YesNo

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 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. At Breakthrough, students will be exposed to new ideas that prepare them for the next grade level. How does your student approach learning outside the classroom?

Parent/Guardian Short Response Answer #1

Your answer is required in order to submit.

2. Breakthrough is committed to students long-term (core 6th-9th grade, then opt-in programming 9th-12th grade), why is being a part of a committed program to college readiness important for your family?

Parent/Guardian Short Response Answer #2

Your answer is required in order to submit.

3. Does your student's behavior support a positive peer community?

Yes

4. Within the past two years, has your student been disciplined at school for violating a code of conduct (ex. detention, in-school suspension, expulsion)?

Yes

5. Please provide the nature of the violation, and the frequency (ex. one time, more than once).

Cat 1. Disruptive, eg. disobedient; Cat 2. Disorderly, eg. fight; Cat 3. Dangerous, eg. extreme physical or mental harm

6. Please provide what corrective strategies supported modifications of the student's behavior.

Tier 1. teachable moment; Tier 2. group intervention enrollment; Tier 3. individual plan.

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 this recommender directly via email.

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.

1a. Recommender's Email:

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:

Additional Paperwork

To complete your application, please submit a copy of the student's Report Card AND a copy of his/her most recent English and Math test scores (examples: MAP, NWEA, TerraNova). Information on where to find and download these items is in the application guide. Please submit these as soon as possible and no later than March 19.

Please select your preference for sharing these documents:

Report Card (.pdf, .png, .jpg)

Test Scores (.pdf, .png, .jpg)

Please upload these documents AFTER YOU SUBMIT THIS ONLINE APPLICATION on our website (www.breakthroughcincinnati.org) OR email the report card and scores to applystudent@breakthroughcincinnati.org

Breakthrough Expectations

I understand that Breakthrough Cincinnati is a four-year, tuition-free, academic enrichment program that seeks highly motivated students to participate in its multi-week summer sessions (one after 5th grade, one after 6th grade, one after 7th grade, and one after 8th grade) and regular school year programming.

If selected, I will ensure that my child attends the academic summer session daily. My student will be present and on-time, every day of the multi-week summer session, except in the case of an emergency. Our family will be committed to Breakthrough and plan family events, such as vacations, around these events. I will communicate any scheduling conflicts or emergencies with the Breakthrough Cincinnati staff.

If selected, I will work with my student to select three school year program sessions to attend. I understand it is important to stay connected with a community of support and enriching experiences year round.

I understand that family involvement is an essential part of my student’s success at Breakthrough Cincinnati. As the parent/guardian of a Breakthrough student, I will attend a variety of family events during the summer and school year, including orientation and Celebration. I will communicate with Breakthrough staff about any concerns in a timely manner and will participate in feedback opportunities.

I understand that my behavior and my student's behavior is indicative of the community we wish to be a part of. Breakthrough is a safe space and we support the values and goals of the program. The language and behavior expectations for myself and my student are to be respectful of my peers and to uphold the values of the program.

I will work with my student to help them maintain at least a “B” average in all of his/her core classes during the school year. If my student is struggling with a class, I will make sure to inform Breakthrough Cincinnati to help my student get the support she/he needs.

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.

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.

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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