Breakthrough Houston Is a Select Program and You Have Been Invited to Apply

STUDENT APPLICATION CHECKLIST 2017 www.breakthroughhouston.org 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 College Bound Program. The College-Bound 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 college-bound 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 College-Bound Program is part of the six year commitment to BTH.

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 – 3, 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: Tuesday, February 14, 2017

______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

______4. FREE AND REDUCED LUNCH ACCEPTANCE + PARENT/GUARDIAN INCOME STATEMENT We need a copy of your free and reduced lunch acceptance (which you can get from your school office) AND a copy of your parent or guardian’s income tax return (1040) with your application. To qualify for Breakthrough Houston, you must be qualified for free or reduced price lunch.

______5. COUNSELOR OR PRINCIPAL FORM Have your parent/guardian complete the COUNSELOR OR PRINCIPAL FORM and you take it to the school Counselor or Principal.

______6. 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 2/14/17 Application Deadline is February 14, 2017 Questions? Contact Ms. Heinzerling at 713 850 4032 or [email protected] Breakthrough Houston, 2401 Claremont Ln. Houston, Tx 77019 1

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/ACT!

2 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, March 4, from 9AM to 11:30PM. 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 four core classes: Literature, Science, Math, and Writing. Along with our core curriculum, students take activities and electives. There are no more than twelve students per class so that students receive individual attention. All classes have “hands on” activities. Imagine dissecting a cow’s eye, 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, Speech and Debate, 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, 2017!! 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, 2017

Breakthrough Houston 2401 Claremont Lane Houston, TX 77019 (713) 850-4032 Office [email protected] www.breakthroughhouston.org

3 BTH STUDENT APPLICATION STUDENT NAME:______DUE DATE: FEBRUARY 14, 2017

Complete this application in ink, not pencil If I am accepted I agree to: 1. Attend Three Summer Six-Week Programs During Middle School 2. Attend School-Year Saturday School 3. Attend the High-School Program 4. Attend Special Events 5. Maintain An Average of 80% Or Above In Every Core Class During The Academic Commitment

Student Signature: ______

STUDENT INFORMATION: Full Name: ______First Middle Last

Home Address:______Number & Street Apt. # 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? ______

If 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/African American American-Indian/Alaskan Native Asian/Asian American Latino/ Hispanic White/ 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 ______Current School ______Grade ______

School ID #: ______T-Shirt Size (circle one below): Type of school: (Circle one) Public or Private or Charter Youth: S M L Adult: S M L XL

BTH STUDENT APPLICATION STUDENT NAME:______4 DUE DATE: FEBRUARY 14, 2017

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, 1) what would you do and why, and 2) where would you go and why? Please answer all parts of the question.

______3. What are three personal qualities/strengths, and how do you see those qualities as being important in your path to college? ______

______

5 BTH STUDENT APPLICATION STUDENT NAME:______DUE DATE: FEBRUARY 14, 2017 STUDENT ESSAY Question: All of us face challenges in life. One challenge might be making new friends. Another might be learning how to play a sport or a musical instrument. Another might be a problem within your own family situation. In a well-developed composition, describe a challenge that you have faced. What lesson did you learn? Support your ideas with examples and details.

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!

6 ______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.

6 YEAR 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, 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.

8 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: ______

Current Email Address(es):

Name: Email:

BREAKTHROUGH HOUSTON PARENT OR GUARDIAN STATEMENT 2017-18

Student’s Name______Current School ______Grade __

Mother/Guardian/Madre Father/Guardian/Padre

Name 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

9 Ethnic Background Ethnic Background Please circle your highest level of education and give Please circle your highest level of education and tell us us what kind of degree you received. what kind of degree you received.

Elementary School Some College Elementary School Some College Middle School College Degree Middle School College Degree High School Post-Graduate Degree High School Post-Graduate Degree Trade School Trade School

Language spoken at home: Language spoken at home:

Are parents (Circle one): Married Separated Divorced Single 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 2017-2018 Page 2

Name of student applicant: ______

A parent or guardian should answer the following questions:

Names and ages of the applicant’s siblings: ______Total number of members in your family ______Why do you want your son or daughter to be a part of Breakthrough Houston? ______

10 ______

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 and how committed are you to making sure your son or daughter attends college? ______Will your family be able to fully commit to Breakthrough Houston for six years? (for three summers and the school year program during Middle School, and the four-year, High-School Program) Circle one: Yes 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 TO GATHER MATERIALS BELOW Counselor or principal’s name: ______

11 Title: ______School: ______

Child’s name : ______Grade: ______

is applying to the BREAKTHROUGH HOUSTON Program sponsored by HISD, Episcopal High School and St. John’s School. 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, 2017

PLEASE SEND COPIES OF THIS CHILD’S: 1. MOST RECENT REPORT CARD 2. LATEST STANDARDIZED TEST SCORES (STARR, STADF, and/or IOWA) 3. Verification of Qualification for Free or Reduced Lunch 4. English and Math Teacher Recommendations

TO: BREAKTHROUGH HOUSTON 2401 CLAREMONT LANE HOUSTON, TX 77019

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.

______Parent or Guardian Signature Date

Questions? Contact Kathy Heinzerling; [email protected] in the Breakthrough Houston Office:

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 6th. Return it in an envelope along with your application to your school representative or mail it to the Breakthrough Houston office by February 14th, 2017. (BTH, 2401 Claremont Ln. Houston, TX 77019)

Please circle the response that best suits the student, in relation to the student’s peers. Academic No basis for Below Average Above Outstanding Judgment Average Average

12 Academic 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

What special interests, talents, or abilities could this applicant contribute to BTH?

Are there any social, academic, or behavioral challenges that this student faces?

Teacher Recommendation continued ►

How could this student benefit from participating in BTH?

Describe this student’s attitude toward homework, studying, and academic achievement. How much effort does this student put into achieving his or her goals? Does this student work AT or ABOVE grade-level in your subject?

BTH is a program for dedicated, hard-working, and motivated students who want to go to college. I recommend this student for the BTH program:

 With great confidence  With confidence  With some confidence (please explain below)  I do not recommend this student (please explain below)

13 Keeping in mind that BTH classes are taught by high school and college students (under the supervision of mentor teachers and program staff), do you have any concerns about this student’s ability to behave appropriately and maturely? Do you have any concerns about this student’s ability to complete the six-year commitment?

If you would like to be included on the BTH mailing list, please write your contact information below (if you are filling out multiple recommendation forms, you need only write your contact information on one form):

Email Address street city zip

Math Teacher Recommendation

Student’s Name ______

School ______

Teacher’s Name ______

Subject(s) Taught ______

Students: Write your name, school, teacher’s name and the exact MATH class he or she teaches you above. Then give this form to your MATH teacher. Ask him or her to return it to you in a sealed envelope by February 6th. Return it in an envelope along with your application to your school representative or mail it to the Breakthrough Houston office by February 14th, 2017. (BTH, 2401 Claremont Ln. Houston, TX 77019)

Please circle the response that best suits the student, in relation to the student’s peers. Academic No basis for Below Average Above Outstanding Judgment Average Average

14 Academic motivation N 1 2 3 4 Attitude towards homework N 1 2 3 4 Study habits/organization N 1 2 3 4 Math 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

What special interests, talents, or abilities could this applicant contribute to BTH?

Are there any social, academic, or behavioral challenges that this student faces?

Teacher Recommendation continued ►

How could this student benefit from participating in BTH?

Describe this student’s attitude toward homework, studying, and academic achievement. How much effort does this student put into achieving his or her goals? Does this student work AT or ABOVE grade-level in your subject?

BTH is a program for dedicated, hard-working, and motivated students who want to go to college. I recommend this student for the BTH program:

 With great confidence  With confidence  With some confidence (please explain below)  I do not recommend this student (please explain below)

15 Keeping in mind that BTH classes are taught by high school and college students (under the supervision of mentor teachers and program staff), do you have any concerns about this student’s ability to behave appropriately and maturely? Do you have any concerns about this student’s ability to complete the six-year commitment?

If you would like to be included on the BTH mailing list, please write your contact information below (if you are filling out multiple recommendation forms, you need only write your contact information on one form):

Email Address street city Zip

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17 PLACEMENT TESTING MANDATORY FOR ALL APPLICANTS.

Saturday March 4, 2017 9:00AM – 11:30AM

St. John’s School – Flores Hall 2401 Claremont Lane Houston, TX 77019

STUDENTS and PARENTS ARRIVE PROMPTLY at 9:00AM

9:00 – 9:20 Registration and Check In

9:20 – 10:00 Student and Parent Meeting:

9:20 to 11:15 Math testing, English testing

11:15 Parents pick-up students

If you DO NOT come to this Placement Testing, your application will be removed from our files. If you have an emergency, please call us at 713 850 4032 or email [email protected]

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18 19 KEEP THIS PAGE

PARENT INFORMATION PAGE 2017-18

Your child has been selected to apply to Breakthrough Houston, a six-year, two-part, tuition-free academic enrichment program. This program seeks highly motivated students to participate in its three six-week summer sessions (one after 6th grade and one after 7th grade and one after 8th grade), its comprehensive school-year program (during the 7th and 8th grade years), and its High-School Program during the high-school years. Breakthrough Houston is committed to a diverse student body representing the variety of ethnic backgrounds in the Houston area.

Family involvement is an essential part of Breakthrough Houston. If your child is accepted to the program, you will be expected to attend a variety of family events during the summer and school year, including orientation, parent meetings, and Celebration evening. You will also be expected to plan family events, such as vacations, around these events. Attendance during the program is mandatory.

APPLICATION DEADLINE DATE: February 15, 2008

If your child attends a BTH target school, have him or her turn in ALL parts of the application to the school Breakthrough Houston coordinator.

If your child does not attend a BTH target school, mail all parts of the application to the address below. MAKE SURE YOU ALSO ENCLOSE A COPY OF YOUR CHILD’S STANDARDIZED TEST SCORES ( and LATEST REPORT CARD AS WELL AS A COPY OF YOUR FREE AND REDUCED LUNCH ACCEPTANCE AND INCOME TAX RETURN.

For more information, contact Ms. Kathy Heinzerling Phone: (713) 850-4032 [email protected] Breakthrough Houston 2401 Claremont Lane Houston, TX 77019 KEEP THIS PAGE