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Nomination Form (2018-2019)


Breakthrough New York (BTNY) is seeking exceptional 6th grade students to join our 10-year college success program!

School administrators/teachers, parents, and even prospective BTNY students themselves are invited to nominate prospective BTNY students for our program.

While anyone can apply to BTNY, completing a nomination for BTNY you will receive the following services:
  • Students: early access to our online application, and reminders about upcoming application deadlines
  • Parents: reminders about upcoming Information Sessions, reminders about student application status and upcoming deadlines
  • School administrators/teachers: application status updates on your BTNY applicants, as well as reminders about Information Sessions and upcoming deadlines
Nominations will be open from October 1st through November 2nd.

To learn more about BTNY, visit btny.org/apply-as-a-student or give us a call at 917-258-6564

Nominator Information

School Nominator Information








Student Nomination (for Parents)










Student Self-Nomination












BTNY Nomination - How-To

School contacts are invited to submit nominations from their school in one of two ways:
  • Option 1: Upload an Excel spreadsheet with the following information: Student First Name, Student Last Name, Guardian 1 E-Mail (Required), Guardian 2 E-Mail (Optional), Student E-Mail (Optional)
  • Option 2: Use the form below to add contact information for your nominated students

Option 1

Please upload your nomination information below:

Option 2

Please use the form below to nominate individual students for BTNY by sharing their contact information. 
If you would like to nominate more than one student please click the "Add another response" link as many times as you need.

If you are missing guardian contact information for any of your students, please input your own contact information instead.






Visit www.btny.org for more information, or call (646) 747-2869