Atlanta. Dear Applicant,

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1 Dear Applicant, Thank you for your interest in Breakthrough Atlanta! We are dedicated to providing our students with a world-class enrichment experience in a setting that is friendly, warm, supportive, and academically charged. Breakthrough has a long tradition of training middle school students who go on to achieve success and become leaders in their respective schools, communities and even their own households. All Breakthrough Atlanta students are encouraged to pursue, engage in and become leaders in scholarly activities. Breakthrough Atlanta is a part of a national collaborative that consists of 33 sites throughout the United States and one in Hong Kong. We operate out of two campuses in Atlanta: The Lovett School and the Atlanta Youth Academy. We have a dual mission: 1) To place middle school students from metropolitan Atlanta s public schools on a six year path to college. 2) To inspire the next generation of teachers by providing a summer teaching internship for college students from around the country. Our staff is dedicated to our mission of College (period) and we strongly believe that our model of Students Teaching Students creates a special chemistry, which must be approached with much care and dedication. We provide all of our students with individualized training and mentoring so that they can pursue their highest aspirations, whether in medicine, law, education or whatever path they choose. Breakthrough Atlanta has been developed as an innovative model for integrating students in a way that dramatically improves both social and educational outcomes. In our summer and school-year programs, students work with college-age students who aspire to make a difference in our community. The teacher interns are supported by certified teachers who bring a variety of educational experiences. Finally, as a program, we feel strongly connected to the community we serve. Our students and teachers reach out in many ways to serve beyond the walls of The Lovett School and the Atlanta Youth Academy. They serve as leaders who commit to community service throughout the city Again, thank you for your interest in Breakthrough Atlanta. We feel that we offer a superior enrichment experience and we hope that you will consider us as the way to foster your student s love, passion and excitement for education. Sincerely, Jeremy Crane, Program Director

2 Breakthrough Calendar Session Date Location Time Student group interviews March 28, 2015 Atlanta Youth Academy 9:00am -4:00pm (half hour intervals) & The Lovett School Acceptance Notifications April 10, & mailings to families N/A Enrollment Packet Return Deadline Date May 1, 2015 The Lovett School Close of Business Day 5pm Student/Family Summer June 13, 2015 Atlanta Youth Academy 9:00am Orientation Student/Family Summer June 13, 2015 The Lovett School 1:00pm Orientation Glover Gym Summer Program Begins June 15, 2015 Lovett School & Atlanta 7:45am - 3:30pm Youth Academy End of Summer Reception July 25, 2015 Atlanta Youth Academy 9:00am -12:00pm End of Summer Reception July 25, 2015 The Lovett School 2:00pm -4:00pm Application Deadline: February 9, 2015 APPLICATION CHECKLIST STUDENT INFORMATION SECTION (completed by student) STUDENT S FAMILY INFORMATION 2 PAGES (completed by student and parent/guardian) EDUCATIONAL RELEASE (signed by parent or guardian) RECOMMENDATION STUDENT S CURRENT REPORT CARD STUDENT S STANDARDIZED TEST SCORES (CRCT, ITBS etc.) *PLEASE NOTE: INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED. FAMILIES/STUDENTS: Keep this page for your information.

3 Student Section On my honor I,, agree to complete the following application in my own handwriting with a pen and without significant help. SIGNATURE: Student s Name Last First Middle Date of Birth Place of Birth City State/Province Country Male Female Current Grade T-shirt Size: Adult Child Social Security Number (Note, this information is confidential and does not determine whether you are accepted or not) Primary/Home Telephone # ( ) Cell Phone ( ) Student s Home Address Number and Street Apartment City State Zip Current School English Teacher First Name Last Name Current School Math Teacher First Name Last Name Current School Ethnicity (Check All That Apply): Caucasian African American West Indian Hispanic/ Latino(a) South Asian East Asian Native American South East Asian Eastern European

4 Parent Section Atlanta Student s First and Last Name Student s School Parent #1 or Guardian #1 Full Name: First Name Last Name Relationship to Student Home Address: Number and Street Apartment City State Zip Code Primary/Home Telephone ( ) Cell Phone ( ) Work Telephone ( ) Highest Grade Completed in School Language(s) Spoken at Home Occupation Employer Parent #2 or Guardian #2 Full Name: First Name Last Name Relationship to Student Home Address: Number and Street Apartment City State Zip Code Primary/Home Telephone ( ) Cell Phone ( ) Work Telephone ( ) Highest Grade Completed in School Language(s) Spoken at Home Occupation Employer

5 Family Status Atlanta The student lives with: (Check all that apply.) * father * mother * grandfather * grandmother * guardian * step-father * step-mother * other (please specify): The parents of the student are (Check all that apply.) * married * separate * divorced * father deceased * mother deceased Is your student a citizen of the United States? * Yes * No Family Education 1. Would your child be first in her/his **immediate family** to attend a 4-year college in the United States? (Check Yes or No) * Yes * No If no, please indicate who in the immediate family (including yourself) has attended college and where: **immediate family pertains to father, mother or siblings Relationship to Student Name of University Years Attended Type of Degree The information requested below is required information. If the information requested is not provided, then your applicant cannot be considered for acceptance into the program. 2. Do you rent or own your home? 3. How many family members reside in your home? 4. (Check Rent or Own ) * Rent * Own 5. Estimated Annual Household Income: $ 6. Does student qualify for free or reduced lunch? * Yes * No 7. Do you have another child in the program? * Yes * No 8. Do you have another child in the program? If yes, name

6 Grade Release Form (Parent/Guardian is responsible for obtaining educational records.) To the Parent or Guardian: Please fully complete this form before submitting it to your child s current school. Student s First and Last Name Date of Birth Student s Current School Address of Student s Current School PARENT OR GUARDIAN PERMISSION I authorize my child s school to release the complete educational record of my child to Breakthrough Atlanta hosted at The Lovett School. I also give permission for Breakthrough Atlanta to access my child s future academic records. Name of parent or guardian: Signature of parent or guardian: Date: To the School: This student is applying to Breakthrough Atlanta, a tuition-free, six-year academic enrichment program at The Lovett School and Atlanta Youth Academy. Breakthrough Atlanta seeks motivated students to participate in its program, which includes a Saturday School Year Program and a Summer Program. If you have any questions regarding our program, please go to or call us at Please give us a complete record of the applicant s grades from the last academic year and most recent standardized test scores. To ensure confidentiality, this release has been signed by the applicant s parent or guardian as part of the application process to Breakthrough Atlanta. Please fax or mail this form and the accompanying information to the fax number or address, respectively, located at the bottom of this page.

7 Math Recommendation Student s Name: School: Math Teacher s Name: Dear Math Teacher, Your student is applying to Breakthrough Atlanta a tuition-free, six-year academic preparation program The Lovett School and Atlanta Youth Academy. The program seeks motivated, enthusiastic, and hardworking students to participate in its program, which takes place for six weeks during the summer and two Saturdays per month during the school year. Breakthrough is committed to a diverse student body representing the variety of ethnic, economic, and geographic backgrounds in the metro Atlanta area. We would appreciate candid responses, which will be kept confidential. Please return this form as soon as possible to the address below: Breakthrough Atlanta 4075 Paces Ferry Road, NW Atlanta, GA Office ext Fax Please rate the student s academic and personal attributes in relation to the other students you have taught. One of the top few I have ever encountered Excellent (top 2% this year) Very Good (top 10% this year) Good (Above Average) Average Below Average Skill Level (general) Basic Arithmetic 6 th or 7 th Grade Math Comprehension Analytical Thinking Motivation & Effort Please consider: self-motivation, intellectual curiosity, enthusiasm for learning, focus, class participation and work ethic. Citizenship Please consider: group work, respect for classmates and community. Behavior (Brief statement) In the space to the right, please provide a brief statement that reflects on the applicants behavior. Consider the applicants respect for class rules, past behavioral incidents, kindness towards others, ability to lead and attitude when presented with academic challenges.

8 English Recommendation Student s Name: School: English Teacher s Name: Dear English Teacher, Your student is applying to Breakthrough Atlanta a tuition-free, six-year academic preparation program The Lovett School and Atlanta Youth Academy. The program seeks motivated, enthusiastic, and hardworking students to participate in its program, which takes place for six weeks during the summer and two Saturdays per month during the school year. Breakthrough is committed to a diverse student body representing the variety of ethnic, economic, and geographic backgrounds in the metro Atlanta area. We would appreciate candid responses, which will be kept confidential. Please return this form as soon as possible to the address below: Breakthrough Atlanta 4075 Paces Ferry Road, NW Atlanta, GA Office ext Fax Please rate the student s academic and personal attributes in relation to the other students you have taught. One of the top few I have ever encountered Excellent (top 2% this year) Very Good (top 10% this year) Good (Above Average) Average Below Average Skill Level (general) Reading Comprehension Writing (structure, grammar) Analytical Thinking Motivation & Effort Please consider: self-motivation, intellectual curiosity, enthusiasm for learning, focus, class participation and work ethic. Citizenship Please consider: group work, respect for classmates and community. Behavior Please consider: respect for class rules, past behavioral incidents, kindness towards others and attitude when presented with academic challenges.