STUDENT APPLICATION CHECKLIST 2011
Breakthrough Houston is a select program and you have been invited to apply.
Welcome to the application process! We are thrilled that you are interested in applying to Breakthrough Houston (BTH). At BTH, middle-school students develop academic and leadership skills. All classes are taught by outstanding high-school and college students. Breakthrough Houston is FREE! Students make a commitment to attend the middle-school, six-week summer sessions and the School-Year Program for three years. Once you have moved on to high school, you become part of the Breakthrough Houston High-School Program. The High-School Program is an additional four-year commitment where you will be supported in your preparation for college. In addition to the summer and school-year program, the high-school program offers many opportunities for college preparation, job opportunities, and enrichment programs all over the country, as well as networking with college-bound high-school and college students. Participation in the High School Program is also expected during high school.
To fill out this application packet, you need to complete several steps. Please follow the directions carefully. We need all of this information to help us make an informed decision about whether BTH would be a good program for you. Use this checklist to help you complete your file. KEEP THIS PAGE and use it to make sure everything is turned in on time. Check off each step once it is complete.
______1. STUDENT APPLICATION
Complete the STUDENT STATEMENT, short answer questions 1 – 4, and the STUDENT ESSAY in your own handwriting. Be sure to use a blue or black pen, not pencil. We suggest you do a rough draft on a separate piece of paper and show it to an adult or older person before you fill out the final application. PLEASE ENCLOSE A SMALL PICTURE WITH THE APPLICATION.
Application is due: February 14, 2011
______2. COMMITMENT CONTRACT and EMAIL AGREEMENT
With signatures and email addresses.
______3. PARENT/GUARDIAN STATEMENT
Have your parent(s) or guardian(s) complete the PARENT SECTION,
including the FREE AND REDUCED LUNCH APPLICATION and include
A COPY OF YOUR PARENT’S INCOME TAX RETURN (1040) with your application.
______4.COUNSELOR OR PRINCIPAL FORM
Have your parent/guardian complete the COUNSELOR OR PRINCIPAL FORM and you take it to the school Counselor or Principal.
______5. TEACHER RECOMMENDATION FORMS
Have your Math and English teachers complete the TEACHER RECOMMENDATION FORMS
If you received this application at your school: DO NOT MAIL IT BACK!
Return parts 1 –4 to the Breakthrough Houston coordinator at your school.
If you did not receive this application at your school: then mail it to the address below before 2/14/11
Application Deadline is February 14, 2011
Questions? Contact Ms. Heinzerling at 713 850 4032 or
Breakthrough Houston, 2401 Claremont Ln.Houston, Tx77019
FREQUENTLY ASKED QUESTIONS
What is Breakthrough Houston?
Breakthrough Houston is a member of the Breakthrough Collaborative. It is a tuition-free, year-round academic program for promising middle- and high-school students from educationally underserved backgrounds. The program consists of school-year Saturday enrichment sessions and a six-week, intensive summer session, which begins the summer after a student’s sixth grade year. After middle school, Breakthrough high-school students participate in a Saturday program which includes PSAT/SAT prep classes, career counseling, college trips and much more.
Who are the Breakthrough students?
Students just like you! Breakthrough students come from many different backgrounds. They share a love of knowledge and desire to go to college. Breakthrough students strive to do their best and are always open to new ideas.
What kind of students apply to Breakthrough?
Motivated 6th graders are eligible to apply. You must have good behavior, above-average grades, and a strong desire to attend college-preparatory high schools and college after high school. Breakthrough students are willing to make a commitment to their education. They love learning and new challenges.
Who are the Breakthrough teachers?
All the teachers are exceptional high-school and college students who enjoy sharing their time and ideas with younger students. With the help of the program’s directors, deans, and mentor teachers, the student-teachers make lesson plans that are fun and engaging.
What is the cost?
Breakthrough is tuition-free. There is NO COST to you or your family. Breakfast and lunch are also provided for free during the summer.
The only cost is your 6 year commitment to the program.
What is the commitment?
This is a six-year program. Your personal and family commitments should be scheduled around Breakthrough for the first three years. Middle school students attend the School Year Program on Saturdays. 7th, 8th, and 9th graders attend the summer program. Once you are in high school, we expect that you will be involved in activities at your school.
But, we still have a Saturday program during the school year that includes tutoring, mentoring and informational seminars about summer jobs, interviewing skills, and the SAT!
How should I fill out the application?
The application should be handwritten in pen, not pencil. You must complete the Student Application by yourself. Your parents have their own application. Remember to write a rough draft of your essays first, and then write the final draft on the application so that we can see your best writing. You will also need recommendations from your Math and English teachers.
What happens after I apply?
An admissions committee reviews the applications. You are required to take placement tests on Saturday, Feb.26 from 9AM to 1PM. You may be called for an individual interview on Saturday, March 5 in the afternoon. Once a decision has been made, a letter will be mailed to you. Information about acceptance will not be given over the phone.
What are classes like?
A former Breakthrough student said, “It’s a program that will challenge your mind, while you have fun...” Students take five core classes: English, Science, Math, History, and a Language. Along with our core curriculum, students take activities and electives. There are no more than ten students per class so that students receive individual attention. All classes have “hands on” activities. Imagine dissecting a cow’s heart, writing a newspaper, or holding a poetry slam!
Are we in class all day?
No! In the afternoon, students have an opportunity to explore new activities or ones they already enjoy. Past courses include Mock Trial, Film, Graffiti Art, Dance, Cooking, and many more. There are also exciting field trips and special events, such as Olympics Day, Career Day and Service Learning.
What about homework, tests, and grades?
Homework and tests are essential to learning. On average, Breakthrough students complete two hours of homework a night during the Summer Program. The teachers design assignments and tests that are thought-provoking. There are no final grades. Instead, students receive written evaluations from their academic teachers.
Is transportation provided?
During the summer, bus transportation is provided for students living within HISD. You and your family are responsible for providing transportation to the School Year Program. Carpools are worked out for students who have a hard time getting to the SYP.
Who gets accepted into Breakthrough?
Admission to Breakthrough Houston is selective. The goal of the admissions committee is to select committed, motivated students who are economically disadvantaged and ethnically diverse. There is no specific quota per public school. You should not be upset if you do not get a space; instead, be proud that you took the risk to apply.
When are applications due?
February 14, 2011!! Applications received at school must be completed and returned to your school representative. If you received your application in the mail or on-line, please mail it back to the address below. We do NOT accept faxed copies.
Deadline for all applications is:
February 14, 2011!
Breakthrough Houston
2401 Claremont Lane
Houston, TX77019
(713) 850-4032 Office
BTH STUDENT APPLICATION STUDENT NAME:______
DUE DATE: FEBRUARY 14, 2011
Complete this application in ink, not pencil
If I am accepted I agree to:
- Attend Three Summer Six-Week Programs During Middle School
- Attend School-YearSaturdaySchool
- Attend the High-School Program
- Attend Special Events
- Maintain An Average of 80% Or Above In Every Core Class During The Academic Commitment
Student Signature: ______
STUDENT INFORMATION:
Full Name: ______
FirstMiddleLast
Home Address:______
Number & StreetApt. # City State Zip
Student email: ______Student cell number: ______
Home Telephone: ______
Social Security Number: ______Date of Birth: ______
Parents’ names: ______
Parents’ email: ______Parents cell number(s): ______
Has any member of your family ever participated in Breakthrough or Summerbridge? ______
Is your answer is “yes,” please state the name and his/her relationship to you? ______
If the answer is “no,” please tell us how you heard about Breakthrough. ______
Ethnic Background: (Circle one)
African-American American-Indian Asian Latino or Hispanic Middle Eastern Pacific Islander
Southeast Asian White or Caucasian Other ______Multiracial (please indicate racial groups) ______
Gender: (Circle one)Male or Female
Is English your first language? ______If not, what language is? ______
What language is spoken in your home? ______
Do both parents live with you at home? ______If not, with which parent do you live? ______
Which parent should we email to talk about grades and progress in school? ______
Elementary School ______CurrentSchool ______Grade ______
School ID #: ______
Type of school: (Circle one) Public or Private
BTH STUDENT APPLICATION STUDENT NAME:______
DUE DATE: FEBRUARY 14, 2011
ANSWER THE FOLLOWING QUESTIONS:
(Please complete these questions in complete sentences. Do this section on your own. Write in blue or black ink.)
1. What are your favorite things to do outside of school (hobbies, special interests, etc.)? Why do you enjoy them?
______
2. If there was one life adventure you could experience, what would you do and where would you go and why?
______
3. Describe a moment in school where you learned something that you will never forget. What did you learn that day and why is it important to you? (This could be anything school related.)______
______
BTH STUDENT APPLICATION STUDENT NAME:______
DUE DATE: FEBRUARY 14, 2011
4. Breakthrough Houston is all about getting into a college-prep high school program and then into college. Why do you want to go to college? How do you think BTH can help you get there?
______
BTH STUDENT APPLICATION STUDENT NAME:______
DUE DATE: FEBRUARY 14, 2011
STUDENT ESSAY
Question: You, like many students your age, are probably concerned about a problem you see in your school, neighborhood, country or the world. Please describe the problem and how you feel about it. Then offer a possible solution to the problem.
To write this essay: 1) Write a rough draft first. 2) The essay should be 2-3 paragraphs. 3) On this section, it is okay to have someone check your essay for grammar and spelling, but the ideas, writing, and words should all be yours. 4) You have the space below to write your essay. You may attach additional sheets. 5) Write your final essay in blue or black pen. Show us your very best writing!
______
EXPRESS YOURSELF!
Please use this box to tell us about yourself. Fill it up—Use your creativity! Put anything here: drawings, poetry, math equations, write a rap, put in photos, write a song or anything else that expresses you.
Commitment Contract
Breakthrough Houston makes a six-year commitment to your family, and we expect the same from you. Please review the Six-Year-Commitment Chart on the next page (yours to keep), and the email expectation agreement below. If you agree to the commitments required, sign below.
Email Expectation Agreement
Breakthrough Houston uses the internet more and more each year. We find it’s the quickest and most reliable way to communicate with students and families, and we’re saving the environment! We require that each new family has at least one email address and checks it at least once per week. Even if you do not have the internet or a computer at your home, it is available for free at schools, libraries, and possibly your place of employment. You can create a free email account at yahoo.com; gmail.com; hotmail.com or many others. By signing below, you agree to maintain email contact with us for the next six years. If your email address (or any other contact information) should change, you will notify the BTH office so we can update your file.
My family understands the commitment that we’re making to Breakthrough Houston and that BTH is making to our family. We’re committed to our success with the program and we’ll do everything we can to uphold our end of the agreement.
Student Name: ______
Student Signature: ______Date: ______
Parent(s) Signature(s): ______Date: ______
Parent(s) Signature(s): ______Date: ______
Current Email Address(es):
Name: Email:
Name: Email:
Name: Email:
BREAKTHROUGH HOUSTON
PARENT OR GUARDIAN STATEMENT 2011
Student’s Name______Current School ______Grade __
Mother/Guardian/Madre / Father/Guardian/PadreName / Name
Address / Address
______
City State Zip / ______
City State Zip
Home Phone / Home Phone
Mobile Phone / Mobile Phone
Email Address / Email Address
Occupation / Occupation
Business Name / Business Name
Business Phone / Business Phone
May we contact you at work? Yes No / May we contact you at work? Yes No
Ethnic Background / Ethnic Background
Please circle your highest level of education and give us what kind of degree you received.
Elementary school Middle school
High School Trade School
College Post-graduate
Degree Degree / Please circle your highest level of education and tell us what kind of degree you received.
Elementary school Middle school
High School Trade School
College Post-graduate
Degree Degree
Language spoken at home: / Language spoken at home:
Are parents (Circle one): MarriedSeparatedDivorcedSingle Parent
With whom is your child living? ______
Does your child receive free or reduced lunch? ____ Yes____ No
Household Income (Please check the correct box):
Less than $10,000
$10,001 to $20,000
$20,001 to $30,000
$30,001 to $40,000
$40,001 to $50,000
$50,001 to $70,000
$70,001 and above
BREAKTHROUGH HOUSTON
PARENT STATEMENT 2011
Page 2
Name of student applicant: ______
A parent or guardian should answer the following questions:
Names and ages of the applicant’s siblings:
______
Why do you want your son or daughter to be a part of Breakthrough Houston?
______
What do you think are your son or daughter’s strengths?
______
______
What do you think are your son or daughter’s weaknesses?
______
Please tell us about your commitment to your son or daughter’s education.
Will your family be able to fully commit to Breakthrough Houston for six years?
(for two summers and the school year program during Middle School, and the four-year, High-School Program)
Circle one:
Yes or no
Parent’s signature: ______
BREAKTHROUGH HOUSTON APPLICATION
COUNSELOR OR PRINCIPAL FORM
PARENTS: PLEASE COMPLETE THE TOP OF THIS FORM AND HAVE YOUR CHILD TAKE IT TO THE SCHOOL COUNSELOR OR PRINCIPAL.
Counselor or principal’s name: ______
Title: ______School: ______
Child’s name : ______Grade: ______
is applying to the BREAKTHROUGH HOUSTON Program sponsored by HISD, Episcopal High School and St. John’sSchool. BREAKTHROUGH HOUSTON is an academic enrichment, tuition-free, year-round college preparatory program. Sixth graders (and some seventh graders) from middle schools are eligible. Applications are due by February 14, 2011
PLEASE SEND COPIES OF THIS CHILD’S:
- MOST RECENT REPORT CARD
- LATEST STANDARDIZED TEST SCORES (NOT TAKS)
TO: BREAKTHROUGH HOUSTON
2401 CLAREMONT LANE
HOUSTON, TX77019
PLEASE NOTE: If you are one of the target schools, this information can be returned to the person designated by the principal and it will be picked up along with the student applications.
Thank you,
______
Parent or Guardian Signature Date
Questions? Contact Kathy Heinzerling; in the Breakthrough Houston Office:
(713) 850-4032
Due Date: February 14, 2011
English Teacher Recommendation
Student’s Name ______
School ______
Teacher’s Name ______
Subject(s) Taught ______
Students: Write your name, school, teacher’s name and the exact ENGLISH class he or she teaches you above. Then give this form to your ENGLISH teacher. Ask him or her to return it to you in a sealed envelope by February 9th. Return it in an envelope along with your application to your school representative or mail it to the Breakthrough Houston office by February 14th, 2011.
Please circle the response that best suits the student, in relation to the student’s peers.
Academic / No basis for Judgment / Below Average / Average / Above Average / OutstandingAcademic motivation / N / 1 / 2 / 3 / 4
Attitude towards homework / N / 1 / 2 / 3 / 4
Study habits/organization / N / 1 / 2 / 3 / 4
Writing skills / N / 1 / 2 / 3 / 4
Reading skills / N / 1 / 2 / 3 / 4
Problem-solving skills / N / 1 / 2 / 3 / 4
Intellectual curiosity / N / 1 / 2 / 3 / 4
Overall academic skills/aptitude / N / 1 / 2 / 3 / 4
Personal
Willingness to try new activities / N / 1 / 2 / 3 / 4
Ability to be a group leader / N / 1 / 2 / 3 / 4
Willingness to volunteer in class / N / 1 / 2 / 3 / 4
Enthusiasm for class projects / N / 1 / 2 / 3 / 4
Ability to work independently / N / 1 / 2 / 3 / 4
Self-confidence / N / 1 / 2 / 3 / 4
Reaction to criticism / N / 1 / 2 / 3 / 4
Sense of humor / N / 1 / 2 / 3 / 4
Concern for fellow students / N / 1 / 2 / 3 / 4
General level of maturity / N / 1 / 2 / 3 / 4
Creativity / N / 1 / 2 / 3 / 4
Ability to work well with adults / N / 1 / 2 / 3 / 4
Overall personal qualities / N / 1 / 2 / 3 / 4
Teacher Recommendation continued ►