6th Grade Nomination Form (2021-2022)

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

School administrators, guardians, and even prospective BTNY students themselves are invited to nominate current 6th grade students to apply to BTNY!

The nomination process is critical to our admissions outreach, as it helps us get directly in touch with a wide group of NYC students who may be eligible for our program.

WHO can be nominated for BTNY?

Students who meet our eligibility criteria, including:

Current NYC 6th graders attending a public, charter, or parochial school
Students who are earn an 83% or above in their core 6th grade classes (ELA, Math, Science, and Social Studies) by the time of their first 6th grade report card
Students who come from a low-income background (see our website to learn more about how we assess this!)

IF you are a school submitting nominations for BTNY, please know that you will be asked to submit the following information for each of your nominees. Having as much contact information as possible helps us make sure we can get in touch with students about applying. The minimum we request is the Student Name, and at least 1 phone number and email address where we can reach the family.

Student Name
Student E-Mail
Guardian 1 E-Mail
Guardian 1 Cell Phone
Guardian 2 E-Mail
Guardian 2 Cell Phone

What is the benefit of submitting a BTNY Nomination?

While you don't need to be nominated in order to apply to BTNY, submitting a nomination for BTNY will help you access the following benefits:

Students: early access to our online application, and reminders about upcoming application deadlines
Guardians: reminders about upcoming Information Sessions, reminders about student application status and upcoming deadlines
School administrators: application status updates on your BTNY applicants, as well as reminders about Information Sessions and upcoming deadlines

Nominations will be open from though January 7th, 2022.

If you need any support in using this form,

please contact Enya O'Riordan, Admissions Director,

at enya@btny.org or call 917-258-6564.

Nominator Information

In order to nominate one or more students for BTNY, please tell us which of the following best describes you as a nominator:

School Nominator Information

School Name:

Nominator First Name

Nominator Last Name

Title/Role:

E-Mail Address:

Are you the best point of contact at your school to share updates with on student application progress, upcoming application deadline reminders, etc.?

If you're not the best point of contact within your school, please enter the full name and e-mail address of a school contact who we can follow-up with about student applications:

Student Nomination (for Guardians)

Parent First Name:

Parent Last Name:

Nominated Student First Name

Nominated Student Last Name

School Name:

Parent #1 E-Mail Address:

Parent #1 Phone Number (Cell Phone preferably!)

Parent #1 Preferred Language:

Parent #2 E-Mail Address (Optional):

Parent #2 Phone Number (Cell Phone preferably!)

Parent #2 Preferred Language (Optional):

Student Self-Nomination

Your First Name

Your Last Name

School Name:

Parent #1 First Name:

Parent #1 Last Name:

Parent #1 E-Mail Address:

Parent #1 Phone Number (Cell Phone preferably!)

Parent #1 Preferred Language:

Parent #2 First Name (Optional):

Parent #2 Last Name (Optional):

Parent #2 E-Mail Address (Optional):

Parent #2 Phone Number (Cell Phone preferably!)

Parent #2 Preferred Language (Optional):

Organization Id

BTNY Nomination Instructions

School administrators are invited to submit nominations from their school in one of two ways:

OPTION 1 (Preferred!): Enter as much of the following information as possible (so we are more likely to reach the student/family): Student Name, Student Email, Guardian 1 E-Mail, Guardian 1 Cell Phone, Guardian 2 E-Mail, Guardian 2 Cell Phone.

OPTION 2: Attach a spreadsheet of the same information listed above.

Option 1 (Preferred)

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 the student's school e-mail or your own contact information instead.

Student First Name:

Student Last Name:

Student E-Mail Address (Optional):

Guardian 1 E-Mail Address

Guardian 1 Phone (Cell preferred!)

Guardian 2 E-Mail Address (Optional)

Guardian 2 Phone (Cell preferred - Optional)

Option 2

Please upload your nomination information below:

Nomination Spreadsheet

Next Steps

By clicking the "Submit" button below. you will be submitting nominations for BTNY. Following submission, our team will begin conducting direct email and phone outreach to your nominees, to encourage them to learn more and apply. Our team will also provide nominators with updates on the admissions status of their nominees.

Summer 2022 Instructional Coach Role!

Every summer, BTNY hires full-time teachers to act as Instructional Coaches in our summer program for middle school students. Instructional Coaches oversee a department of 3 undergraduate Teaching Fellows in one of four academic disciplines (Literature, Math, Science, and Social Studies.)

This role was designed to support classroom teachers who are interested in developing their skills as instructional leaders. Past Instructional Coaches have gone on to become Academic Deans and Instructional Coaches in full-time school settings.

All nominators are encouraged to apply online (or share with your networks) by January 30th, 2022.