| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Byenveni nan Aplikasyon pou Elèv nan Breakthrough Greater Boston 2020-2021

Dat limit aplikasyon: 26 fevriye, 2021

Welcome to the Breakthrough Greater Boston Student Application 2020-2021

Application Deadline: February 26, 2021

Our mission at Breakthrough Greater Boston is to inspire excitement for learning, create paths to college, and promote careers in education. 

Breakthrough Greater Boston prepares students for success in college and trains the next generation of urban teachers using a unique Students Teaching Students model. Through our six-year program, students gain a passion for learning and the perseverance and tools to succeed in college and beyond. 

This application is for students and parents/guardians to complete. If you have any questions, reach out to admissions@btgbmail.org and we will be in touch shortly.

Application Site

Application Cohort
Enfòmasyon Jenneral sou Elèv la ak sou Fanmi li

First Name

Middle Name/Initial

Last Name

Gender

Pronouns

Gender Details (Optional: Clarify or provide additional details)

Date of Birth (MM/DD/YYYY)

Race (If multiple, select Multiracial)

Ethnicity/Nationality (Ex: Salvadoran, Bengali, Dominican, etc.)

Street Address

City

State

Zip Code

Student's Email Address (School or Personal Email Address)

Student's Phone Number (If none, leave blank.)

T-Shirt Size
Enfòmasyon sou Lekòl la

Current School
Enfòmasyon sou Fanmi an

Home/Primary Language

Additional Home Language

Language(s) spoken at home if "Other" was selected for either response above:

Is English the student's first language?

If no, what is the student's first language?

Student Eligible for Free/Reduced Lunch

Family Income Range

Is applicant a sibling of current or former Breakthrough Greater Boston student?

What is/are the Sibling(s) Name(s)?

# of Children in the Home (including applicant):

Please list the names and ages of all individuals in the home UNDER age 18:

Please list the names and ages of all individuals in the home 18 or OVER:

Tann! Sove pwogrè ou! Wait! Save your Progress!

Pandan w ap konplete seksyon nan aplikasyon ou an, pa bliye pou konsève pou li pou ke ou ka tounen vin jwenn li pita. Pa enkyete-ou ka kontinye travay sou li kounye a, men asire w ke ou sove li jan ou fè pwogrè.

As you complete sections of your application, don’t forget to save it so that you can come back to it later. Don’t worry—you can keep working on it right now, but make sure you save it as you make progress.
Saving Instructions
Enfòmasyon sou Paran oswa Premye Responsab Legal la

First Name

Middle Name

Last Name

Gender

Gender Details (Optional: Clarify or provide additional details)

Pronouns

Race

Ethnicity/Nationality (Ex: Salvadoran, Bengali, Dominican, etc.)

Relationship to Student

Lives with Applicant?

Mailing Street

City

State

Zip Code

Home Phone

Mobile Phone

Preferred Phone

Parent/Guardian #1 Email Address

Preferred Means of Contact

Preferred Verbal Language

If Other Verbal Language, please enter:

Preferred Written Language

If Other Written Language, please enter:

Education Completed

If Other, please specify:

In what country did you complete your education?
Enfòmasyon Anplis sou Paran oswa Responsab Legal la
I would like to provide information about a second Parent/Guardian:
Enfòmasyon sou Paran oswa Dezyèm Responsab Legal la

First Name

Middle Name

Last Name

Gender

Gender Details (Optional: Clarify or provide additional details)

Pronouns

Race

Ethnicity/Nationality (Ex: Salvadoran, Bengali, Dominican, etc.)

Relationship to Student

Lives with Applicant?

Mailing Street

City

State

Zip Code

Home Phone

Mobile Phone

Preferred Phone

Parent/Guardian #2 Email Address

Preferred Means of Contact

Preferred Verbal Language

If Other Verbal Language, please enter:

Preferred Written Language

If Other Written Language, please enter:

Education Completed

If Other, please specify:

In what country did they complete their education?
Enfòmasyon Konplemantè

Child Resides with:

Will the student be a First Generation College Student? (neither parent has a 4-year degree from United States)
Reponn Kounye a oswa Pi Ta ?

Would you prefer to answer the next few questions in writing here or in person (via phone/Zoom)?

Why do you want your child to be a part of Breakthrough?

Has your child experienced any significant stress in their life (for example: the death or serious illness or a parent, guardian or sibling; the deportation or incarceration of a parent, guardian, or sibling)?


Please tell us anything else you would like us to know about you and/or your child:

Student Statement

Directions for Completing the Student Statement: - Complete all questions independently. You may brainstorm your answers with a teacher, but all answers must be your own work. - Write in complete sentences and make sure you answer the question fully. Breakthrough wants to see your best writing! - There is no sentence or word minimum or maximum; answer each question thoroughly.




Student Essay

In 1-2 paragraphs, tell us why you want to come to Breakthrough. Please answer both of the following questions. - Why do you want to be a Breakthrough student? - What are your goals and how will Breakthrough help you achieve them? Remember: This should be your best work! We encourage you to write a first draft and submit your final draft after you have proofread and edited it.

Sèvis Sipò pou Travay nan Lekòl
Does your child receive academic support services at school (Ex: IEP or 504 Plan)?

Plan Type

IEP or 504 Plan Grade Level


Receiving ELL Support Services:
Enfòmasyon sou Lane Klas / Matyè


Grade Level of Report Card Submitting:

School Year of Report Card Submitting:

School Term of Report Card Submitting: (Ex: For Semester 1 or Trimester 1 select "Cycle 1")
Rekòmandasyon Pwofesè
Tanpri, bay non ak adrès elektwonnik yon pwofesè ki kapab ekri yon rekòmandasyon pou ou. N ap voye fòmilè a ba li nan kouryèl, men sa kapab yon bon lide, pou fè li konnen kouryèl la pral vini!

Please provide the name and email address of a teacher that can complete a recommendation form for you. We will email them the form, but it may be a good idea to let them know it's coming!

Recommender Name

Recommender Email Address

Parent/Guardian Commitment: By typing my name below, I signify that I understand that my child’s attendance during all parts of the program is mandatory. I also understand that my attendance at all scheduled family events is mandatory. I agree that I will try to the best of my ability to schedule all appointments, family events, trips, and any other activities around these dates to ensure my child’s full participation in the program.

It takes a bit of time to process after you hit "Submit"
Please do not click submit again. Thanks for your patience!