Breakthrough Louisville Student Application

STUDENT APPLICATION

Due May 1, 2024
Checklist of forms needed to complete the application process:

 Student Statement
 Parent / Guardian Statement
 Counselor Form
 2 Academic Teacher Reference Forms

You will be notified by phone or email if your application is not complete.

Three reasons you should apply to be a Summerbridge Scholar:
- You gain the edge to become a leader.
  You strengthen your skills to be an even more successful student.
  You meet new and exciting people from other Jefferson County Public Schools and from across the country.
Students who are accepted into the program:
- Are motivated and hardworking
- Are enthusiastic about learnin
- Complete their applications in a timely manner
- Have solid teacher recommendation
- Have at least a C grade average or higher
Maintaining the Scholarship privilege

Requires a strong 2-year commitment from the family.
Students can have no more than 3 absences excused or unexcused from the summer program.

Benefits of being a Summerbridge Scholar
- Summer excitement and learning
- School year enrichment
- School year advocacy
- High School Counseling
- Fun, fun, and more fun with students and young teachers in training
Hours

Summer Program hours are 8:15 am — 3:45 pm

After school tutoring as needed

Transportation

Buses will be scheduled to pick up and drop off students at central locations. Bus pickup sites will be determined based on student enrollment.

You will be notified by phone or email if your application is not complete.

Important Program Dates: (dates may be pushed back if snow days cause schools to go longer into June)

Summer program begins – June 10

Summer program ends – July 19
Person to contact in case of emergency:*
Parent/Guardian
Child's Name*

First NameLast Name
Gender*

malefemaleOther
Pronouns*
School Student is Attending in the Fall (of 2024)
Birth Date*

MonthDayYear
Race / Ethnicity*
Mobile Number
Preferred Contact Number for Staff to Contact During the Program
Postal Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Emergency Contact Relationship*
ex. Father, Mother, etc.
Phone Number of person to contact in case of emergency

Open Answer Questions

Please complete the following in full sentences.
Why do you want to go to Summerbridge?
What about Summerbridge excites you?
You will be required to complete homework during Summerbridge. How do you feel bout this?
Name three things you like about school and why
Identify two challenges you face at school in detail.
Do you feel school is easy, hard, or just right? Explain.
What makes you unique?
List any extracurricular activities you participate in.
Who is someone you admire? Explain why.
What is something you want to learn about this summer?

Essay Submission

Write few paragraphs on the topic below.
What job do you want to have when you grow up? What steps can you take to get you there? What are you doing now to reach your goal? How well do you feel you need to do in school to have that job?

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OR PASTE INFO BELOW: What job do you want to have when you grow up? What steps can you take to get you there? What are you doing now to reach your goal? How well do you feel you need to do in school to have that job?

Statement of Authenticity

I certify that, to the best of my belief, the information I have provided is complete and true.
Signature of Applicant

First NameLast Name
Date

daymonthyear
Should be Empty:

STUDENT APPLICATION

Checklist of forms needed to complete the application process:

You will be notified by phone or email if your application is not complete.

Three reasons you should apply to be a Summerbridge Scholar:

Students who are accepted into the program:

Maintaining the Scholarship privilege

Benefits of being a Summerbridge Scholar

Hours

Transportation

Open Answer Questions

Essay Submission