Parent Informational Signup/New Student Interest Form(Summer 2026) 
Summer 2026 Summer Program Date: June 8th - July 10th Monday-Thursday 
Ready to become a Breakthrough Scholar?

Get a head-start on the school year.
Join a group of kids as motivated as you are.
Come to a place where it's cool to be smart.
Meet high school and college age role models.
Be an inspiration to your community.

To receive more information about our amazing tuition free 6-year academic enrichment program including 5-week Summer Program and Saturday School Year Program, complete the interest form below and sign-up for one of our virtual informational sessions (dates listed below). Also visit our website https://breakthroughatlanta.org for more information. 

IMPORTANT NOTE: THIS GOOGLE FORM  IS NOT THE OFFICIAL STUDENT OF APPLICATION. THIS SERVES AS AN ACKNOWLEDGEMENT OF INTEREST. ABOVE LINK IS THE APPLICATION 
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Parent Name (First, Last): *
Parent email address: *
Parent phone number: *
Preferred method of contact: *
Required
Student name (First, Last): *
Current school: *
Current grade level: *
Are you a First Generation College Student ? 
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Do you reside in a Single Parent Household ?
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Do you qualify for Free and Reduced Lunch?
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How did you hear about us? *
If "Other", please share:
If "Family friend" or "Breakthrough scholar", please list their name (First, Last):
Have you attended a Parent Informational Session? (Note: Parents are required to attend at least one informational session prior to submitting an application. Sessions can occur in-person during school events or virtually) *
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