Student Application - 2022
PLEASE NOTE — we are fully enrolled for rising 7th & 8th grades.  Applications are currently being accepted for rising 6th & 9th grade students only.

Breakthrough of Greater Philadelphia is a tuition-free academic and co-curricular enrichment program that helps launch highly-motivated middle school students on a path to competitive high schools, setting a critical foundation for college and career success.  Programming for students and families begins in the summer before 6th grade and continues during the school year until 9th grade.

Please complete this application and we will reach out to schedule an interview.
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Электронная почта *
Student First Name *
Student Last Name *
Student Date of Birth
ДД
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ММ
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ГГГГ
Gender
Street Address *
City, State, Zip Code *
Current School *
Current Grade *
If student attends a School District of Philadelphia school, please list SchoolNET number.
Primary Ethnicity
Primary Language Spoken at Home
Does the student live in a single-parent household?
What is the marital status of the student's parents?
Would the student be the first person in the family to earn a bachelor's degree?
Parent 1 First Name *
Parent 1 Last Name *
Parent 1 Phone Number *
Parent 1 Email Address *
Parent 1 Occupation
Parent 1 Employer
Parent 1 Highest Level of Education Completed
Parent 2 First Name *
Parent 2 Last Name *
Parent 2 Phone Number
Parent 2 Email Address
Parent 2 Occupation
Parent 2 Employer
Parent 2 Highest Level of Education Completed
Does your family meet the qualifications for Free/ Reduced Price Lunch? *
Подпись отсутствует
What was your annual household income in 2021? *
How many people live in your home? *
Before beginning the Breakthrough program, students must be fully vaccinated for COVID-19 and if eligible, received a booster. Proof of vaccination will be required.
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