Have Fun
Learning
Challenge
Yourself
Make New
Friends
Prepare for
College
Reach Your
Potential
Accepting
Applications
for 5th & 6th
Grade
Students
New
Student
Application
Application Deadline:
March 20, 2015
Submit Applications To:
BREAKTHROUGH CINCINNATI
Our MissionBreakthrough Cincinnati’s mission is to increase the educational opportunities of motivated middle school students, and to inspire and train the next generation of educators.
Our Program
Breakthrough Cincinnati (BTC) supports over 100 rising 6th, 7th, 8th, and 9th grade students by offering rigorous, tuition-free, year-round enrichment and academic support. BTC employs a unique ‘students teaching students’ model in which talented high school and college students serve as teachers, role models, and mentors to our middle school students. BTC provides students with the skills and motivation needed to enter and succeed in college preparatory high school programs with the ultimate goal of graduating high school and matriculating to four-year colleges and universities. In addition, BTC provides early training and experience for high school and college students interested in exploring careers in education.
Each Summer, BTC conducts a six-week academic session in which middle school youth develop the necessary organizational, study, critical thinking, and communication skills needed to succeed in rigorous college preparatory high schools. Students take morning courses in language arts, writing, math and science in small classes of six to eight students. In the afternoon, students attend foreign language classes and academic electives, life skills and organizational workshops, and participate in athletic or artistic courses.
During the school year, Breakthrough Cincinnati remains invested in the academic success of our students. We work to support students who encounter barriers to educational resources during the academic calendar. Breakthrough monitors students’ grades by collecting report cards or advocating for students when needed, and making families aware of tutoring and academic enrichment opportunities.
Our Students
Breakthrough Cincinnati students come from many different backgrounds. They all share a love of learning and want to go to college. Breakthrough Cincinnati students strive to do their best and are always open to new ideas and experiences. They work hard, develop leadership skills, and have fun in the process.
Our Teachers
Breakthrough teachers are talented high-school (juniors and seniors) and college students. They work long hours to make learning exciting, challenging, and rewarding. Our teachers are special because they possess a love of learning and a desire to share their time and ideas with younger students. These young teachers work hard to provide high quality, engaging instruction to our students, and are supported by professionals to succeed in the classroom.
Our Contact
Breakthrough Cincinnati
Frequently Asked Questions
What is the commitment?Both student and family must agree that, if accepted, you will schedule other activities around the dates of the summer program for four years. Breakthrough students attend our summer program Monday-Friday from 8am to 3pm for six weeks in the summer. Students and families must also attend a student Orientation in the spring. The first day of the summer program is Monday, June 22 and the last day is Friday, July 31. To wrap up our program, we host an event called CELEBRATION on Saturday, August 1 from 2:00 pm to 4:00 pm where students get to show their families and friends what they’ve been learning all summer through an interactive open house and performance. Attendance at Celebration is mandatory for ALL students. Attendance is required every day during the entire
six-week summer program. Students and families who do not adhere to the attendance expectations will be asked to leave the program.
Dates of Summer Program 2015: Summer Program: June 22 – July 31
Celebration: Saturday, August 1
What about homework, tests, and grades?
The Breakthrough program is designed to prepare students for challenging middle and high school courses. Homework and tests are part of rigorous learning environments. Breakthrough Cincinnati students complete ONE to TWO hours of homework a night and have end of summer exams. The teachers design assignments and tests that are thought-provoking. Teachers may grade assignments, but there are no final grades. In replace of grades, students receive written evaluations from their academic teachers, which are then sent to the student’s school and home.
Is transportation provided?
Yes, Breakthrough provides transportation. With much effort, we try but cannot guarantee stops within one mile of a student’s home if that student lives within 18 miles of Cincinnati Country Day School. Some students will have to walk to a designated intersection or be driven to a stop a mile from home. Students residing further than 18 miles can receive transportation from a satellite site in their community. Bus routes will be mailed to families at least one week prior to the summer program start date.
What will it cost?
Breakthrough Cincinnati is a tuition-free, academically-rigorous enrichment program. There is no financial cost to the student or family. Breakfast, lunch, and supplies are provided during the summer. The only cost to Breakthrough students and families is commitment, hard work, and attendance.
Any important advice?
APPLICATION CHECKLIST
We are delighted that you are interested in the new challenges, fun experiences, and exciting opportunities offered by Breakthrough Cincinnati. In order for your application to be considered, all four sections of the application needs to be completed. Only completed applications will be reviewed by the committee. Be sure to write the student’s name is at the bottom of each page. Use this page as a checklist to keep track of which parts of your application have been completed. Please keep this check list, along with the program description and frequently asked questions for your reference.
o STUDENT SECTION Pages 1-4
Students should complete these pages in their own handwriting, using a black or blue pen, not pencil. We also encourage each student to complete a rough draft on a separate piece of paper and have someone proofread it before filling out the application form in pen. Please do not submit the rough draft. Make sure your application is neat and presentable before submitting it. This section can be sent in as soon as you finish it.
o PARENT/GUARDIAN SECTION Pages 5-10
The parent(s) or guardian(s) must complete these pages. This section can be sent in as soon as it is finish it.
o TRANSCRIPT RELEASE FORM Page 11 - 12
A parent or guardian must sign this form and give it to either the student’s principal or administrative office. The school is able to mail or fax the requested transcripts directly to Breakthrough. Parents are also welcome to request and submit the transcripts directly to Breakthrough with the other application materials.
o TEACHER REFERENCE FORM Pages 13-14
One of the student’s academic teachers (an instructor of language arts, math, history, or science) must complete the teacher reference form. The teacher should mail the completed form directly to our office in a sealed envelope.
*We must have ALL sections of your application by the deadline in order for it to be considered. Incomplete applications will not be reviewed by the committee. If you have any questions about our program,
please call us at 513-979-0339 or email to Patrice Pennington at [email protected].
Please send application materials to: Breakthrough Cincinnati ATTN: Ms. Patrice Pennington, Program Director
6905 Given Road Cincinnati, OH 45243
(513)527-7627 (fax)
Electronic files can be sent to [email protected].
1 _________________________________________________________
Student’s Name
Student Information
Student, please write your name at the bottom of each page of the application and complete the student section in pen.
Name: ___________________________________________________________________________________
First Name Middle Name Last Name
Date of Birth: ___________________________ Gender (circle one): Female Male
Address: __________________________________________________________________________________ Street/Apt #
__________________________________________________________________________________
City/State/Zip
Home Phone: _____________________________ Cell Phone: ____________________________
Student’s Email Address: ______________________________________________________________________
Current School: __________________________________________________ Grade: ____________________
Please name the academic teacher who will write your reference: _______________________________________
Did any of your siblings attend Breakthrough, formerly known as Summerbridge Cincinnati (circle one)? YES NO If so, please list their name(s) and years attended.
1. _________________________________________________________ Name Year 2. _________________________________________________________ Name Year 3. _________________________________________________________ Name Year
How did you find out about our program? _________________________________________________________
Are you currently enrolled in the Boys Hope Girls Hope Program (circle one)? Yes No
2 _________________________________________________________
Student’s Name
Short Answer
Please answer all of the questions below in complete sentences. Attach additional paper if you need more space. 1. What are your top three favorite things to do when you are not in school?
a._________________________ b._________________________ c._________________________
2. Name one of your favorite books and explain why it’s your favorite.
3. Who is someone you admire? Explain why you admire this person.
4. Tell us about an accomplishment you are most proud of. Why is this accomplishment important to you?
5. At Breakthrough, students usually spend 1-2 hours on homework each night during the summer. How do you feel about completing 2 hours of homework per night during the summer program?
6. What subject do you enjoy most in school? Please check one:
Language Arts Math Science Social Studies Foreign Language Other Please explain why you enjoy this subject the most.
7. What subject is the most difficult or challenging for you? Please check one:
3 _________________________________________________________
Student’s Name
Student Statement
Directions: Your answers to these questions should be one paragraph each. It is okay to have someone check your work for grammar and spelling, but the ideas, writing, and words should be yours. Write a rough draft first on a separate sheet of paper. You do not need to submit your rough draft with your application. Write your final draft in (black/blue) pen below.
1. Breakthrough Cincinnati is a college preparatory program that will prepare you for college. Please write about why you think going to college is important to you, your family, and your career goals.
4 _________________________________________________________
Student’s Name
Student Essay
Directions: Your answer to this essay question should be 3 paragraphs. It is okay to have someone check it for grammar and spelling, but the ideas, writing, and words should be yours. Write a rough draft first on a separate sheet of paper. You do not need to submit your rough draft with your application. Write your final draft in pen below.
5 _________________________________________________________ Student’s Name
Parent/Guardian Section
Parent/Guardian Information Mother Step-Mother Guardian: ___________________ Student lives with thisparent/guardian ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Employment Information ___________________________________ ___________________________________ ___________________________________ ___________________________________
Highest level of education completed: Grade _______
High School Diploma/GED
Technical/Vocational Certification Associate Degree Bachelor’s Degree Master’s Degree Graduate Degree Doctoral Degree Father Step-Father Guardian: __________________ Student lives with this
parent/guardian ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ Employment Information ____________________________________ ____________________________________ ____________________________________ ____________________________________
Highest level of education completed: Grade _______
High School Diploma/GED
Technical/Vocational Certification Associate Degree Bachelor’s Degree Master’s Degree Graduate Degree Doctoral Degree First Name Last Name Address Address 2 City, State, Zip
6 _________________________________________________________
Student’s Name Parents/Guardians are:
Married Single Separated Divorced Mother Deceased Father Deceased With whom is the student living? _____________________________________________________________
Please explain any custodial arrangements. _____________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ Student’s Racial/Ethnic Background:
African-America/Black Caucasian/White Self-Identify (below) American Indian/Native American Hispanic/Latino ________________________
Asian Multi-Racial ________________________
Is your student multi-lingual (check one)? Yes No If so, what languages does your students speak? ___________________________________________________________________________________________
What language is spoken most often in your home? ________________________________________________
Sibling Information: Please attach another sheet of paper if necessary.
___________________________________________________________________________________________
Full Name Age Relation to Student
___________________________________________________________________________________________
Full Name Age Relation to Student
___________________________________________________________________________________________
Full Name Age Relation to Student
Does your child receive free or reduced priced lunch? Yes No Annual Household Income (please check one):
Less than $15,000 $15,001 - $30,000 $30,001 - $45,000 $45,001 - $60,000 $60,001 - $80,000 $80,001 and above
We declare that the information reported on this form, to the best of our knowledge and belief, is a true and accurate statement of our financial situation.
______________________________________________________ _____________________
Signature of Parent or Guardian 1 Date
_____________________________________________________ _____________________
7 _________________________________________________________
Student’s Name
Parent Short Answers
Please answer the questions below. Attached additional paper if necessary. 1. Please describe your student in three words.
______________________________, ________________________________, ___________________________
2. What special activities does your child participate in (i.e., piano lessons, service program, church group, sports)? _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________
3. Tell us about a time when you were most proud of your student.
_____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________
4. Why would you like your student to enroll in Breakthrough Cincinnati?
_____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 5. On average, how much time does your student spend on homework each night? _________________________ b. Is this too much, not enough, or just the right amount of homework for your student (circle one).
6. Is your student on an IEP, 504 Plan, or receive any special accommodations in the classroom for learning difficulties? Please explain.
_____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________
Please list the name and location (city and state) of the schools your student has attended:
5th Grade School________________________________________ Location _______________________________ 4th Grade School________________________________________ Location _______________________________
8 _________________________________________________________
Student’s Name
BUS TRANSPORTATION
Student Name: _______________________________________________________________________________
If selected into the program, during the summer:
My student will use the bus transportation provided by Breakthrough for both morning pick-up and afternoon drop-off.
My student will use the bus transportation provided by Breakthrough for morning pick-up, but NOT for afternoon drop-off.
My student will use the bus transportation provided by Breakthrough for afternoon drop-off, but NOT for morning pick-up.
My student will NOT use the bus transportation provided by Breakthrough this summer. I realize that I am responsible for my student’s transportation to and from Breakthrough.
Address for morning pick-up:
_____________________________________________________________________ Street Address
_____________________________________________________________________
City State Zip
Phone number: _________________________________________________________
Address for afternoon drop-off:
_____________________________________________________________________ Street Address
_____________________________________________________________________
City State Zip
Phone number: _________________________________________________________
* When considering transportation arrangements please be mindful that every Wednesday is Early Release and students are dismissed one hour earlier than normal.
9 _________________________________________________________
Student’s Name
STATEMENT OF INTENT
I understand that Breakthrough Cincinnati is a four-year, tuition-free, academic enrichment program. This program seeks highly motivated students to participate in its six-week summer sessions (one after 5th grade, one after 6th
grade, one after 7th grade, and one after 8th grade).
My child will attend the Academic Summer Session and participate in the school year Super Saturday program. My student will be present and on-time, every day of the six-week summer session, except in the case of an emergency. Our family will be committed to Breakthrough and plan family events, such as vacations, around these events.
Family involvement is an essential part of Breakthrough Cincinnati. As the parent/guardian of a Breakthrough student, I will attend a variety of family events during the summer and school year, including orientation, student-led parent/teacher conferences, and Celebration.
I will work with my student to help them maintain at least a “B” average in all of his/her core classes during the school year. If my student is struggling with a class, I will make sure to inform Breakthrough Cincinnati to help my student get the support she/he needs.
10 _________________________________________________________
Student’s Name
This page has been left blank intentionally
for easy distribution.
To learn more about Breakthrough,
please call at 513-979-0339 or
visit us on the web at
www.breakthroughcincinnati.org
11 _________________________________________________________
Student’s Name
Release of Student Records
This educational release form allows Breakthrough Cincinnati to collect your student academic records. Student Transcripts must be submitted in order for the application to be complete and considered for admission to the program. All portions of the application are due to Breakthrough Cincinnati by Friday, March 20, 2015. IMPORTANT: Please complete this form and submit it to your student’s administrative office so that the school may release the required information to Breakthrough Cincinnati.
Attention: ___________________________________________ School: __________________________________ (Principal’s name)
My student, _______________________________________________, is applying to the Breakthrough Cincinnati program, a tuition-free academic enrichment program for middle school student. To support his/her application, I hereby grant permission for the release of the following documents to Breakthrough Cincinnati:
a. Most recent standardized test scores b. 2013/14 Full Year Report Card c. 2014/15 Report Card to Date
Parent/Guardian’s Signature: ________________________________________________ Date: _____________
Please mail or fax the required document to the attention of Patrice Pennington, Program Director, no later than Friday, March 20, 2015. You are also welcomed to send electronic copies of the documents to
[email protected]. If you have questions, you are welcome to call the office at 513-979-0339. To learn more about our program or gain additional copies of the application, visit us at www.breakthroughcincinnati.org.
Breakthrough Cincinnati
6905 Given Road
Cincinnati Ohio 45243
12 _________________________________________________________
Student’s Name
This page has been left blank intentionally
for easy distribution.
To learn more about Breakthrough,
please call 513-979-0339 or
visit us on the web at
www.breakthroughcincinnati.org
13 _________________________________________________________
Student’s Name
Teacher Reference Form
Student: _________________________________ School: ______________________________ Grade: ______
Teacher: _________________________________ Subject: ______________________________
This student is applying to Breakthrough Cincinnati, a tuition-free, academic enrichment program. Breakthrough
Cincinnati seeks highly motivated and talented students who have mostly A’s and B’s, demonstrate good behavior, and have regular classroom attendance with few tardies to participate in its six-week summer session with your-round support and enrichment activities. Breakthrough strives to prepare its students for college-preparatory high school
programs. Students accepted into the program will take summer classes taught by highly talented high school and college students who are aspiring to pursue careers in education. Breakthrough is committed to a diverse student body representing the variety of ethnic and economic backgrounds of the city of Cincinnati.
We would appreciate your candid responses, which will be kept confidential. If you have any questions regarding the program, please call the Breakthrough office at 979-0339. Please complete this form, sign over the seal of the
envelope, and mail it to the Breakthrough Cincinnati office. Submit completed forms no later than March 20, 2015 to: Breakthrough Cincinnati, 6905 Given Road, Cincinnati, OH 45243. You are also welcome to fax documents to
(513)527-7627 or email electronic copies to [email protected].
Please circle the response that most closely reflects your observations of the student named above.
(over)
Academic Qualities Poor Fair Good Excellent No Basis for Judgement
A. Academic Motivation 1 2 3 4 N/A
B. Attitude toward homework 1 2 3 4 N/A
C. Study Skills 1 2 3 4 N/A
D. Writing Skills 1 2 3 4 N/A
E. Math Skills 1 2 3 4 N/A
F. Intellectual Curiosity 1 2 3 4 N/A
Personal Qualities 1 2 3 4 N/A
A. Willingness to try new activities 1 2 3 4 N/A
B. Perseverance in completing task 1 2 3 4 N/A
C. Ablility to be a group leader 1 2 3 4 N/A
D. Willingnes to volunteer during activities 1 2 3 4 N/A
E. Self-confidence 1 2 3 4 N/A
F. Reaction to criticism 1 2 3 4 N/A
G. Sense of humor 1 2 3 4 N/A
H. Concern for others 1 2 3 4 N/A
I. Contributes to a positive learning environment 1 2 3 4 N/A
G. Sense of humor 1 2 3 4 N/A
14 _________________________________________________________
Student’s Name
1. What makes this student distinct from other students in your class?
_____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 2. How would Breakthrough Cincinnati most benefit this student? What needs should be addressed?
_____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 3. Please describe parental involvement with this student’s education.
_____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 4. How does this student interact with peers? Are there any behavior problems that occur inside or outside of class? _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 5. We expect our students to be self-motivated learners. How often does this student work beyond your
expectations?
_____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 6. Is this student on an IEP, 504 Plan, or have any special accommodations of which we should be aware? Please
explain.
_____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 7. I recommend this student to the Breakthrough Program:
With great enthusiasm With confidence With reservation I do not recommend 8. Please feel free to use this space to add any comments about this student.
