Nomination Form

Breakthrough New York (BTNY) is seeking exceptional 6th grade students to apply to our 10-year college success program!

The nomination process is critical to our admissions outreach, as it helps us get directly in touch with a wide group of NYC students who may be eligible for our program.

For more information about our program and how to support your nominees in our admissions process, please download our Student Admissions Engagement Guide for Schools and CBO Partners.

WHO Should I Nominate for Breakthrough New York?

Students who meet our academic eligibility criteria, including:

Current NYC 6th graders attending a public, charter, or parochial school
Students who scored a Level 3 or higher on the 2023–2024 Standardized State Assessment

Students who have an 85% or above in their core 6th grade classes (ELA, Math, Science, and Social Studies) by the time of their first 6th grade report card

WHAT Information Do I Need to Submit in My Nominations?

You will be asked to submit the following information for each of your nominees. Having as much contact information as possible helps us make sure we can get in touch with students about applying.

Required:

Student Name
Student E-Mail
Guardian 1 E-Mail
Guardian 1 Cell Phone

Optional (but Strongly Encouraged):

Student Gender
Student Race/Ethnicity
Guardian 2 E-Mail
Guardian 2 Cell Phone

Note: Providing Gender and Race/Ethnicity data helps BTNY lead our nomination and admissions process with an equity lens.

Questions?

If you need any support in using this form, please contact Andrew Lindsay, Director of Admissions, at andrew@btny.org or call 917-633-5757.

Nominator Information

School Name:

Begin typing to search for your school. If your school is not listed, leave this field blank and type your school's name in the "School Name if 'Other'" field below.

School Name if "Other"

Nominator First Name

Nominator Last Name

Title/Role:

E-Mail Address:

Phone

Are you the best point of contact at your school/organization to share updates with on student application progress, upcoming application deadline reminders, etc.?

If you're not the best point of contact within your school/organization, please enter the full name and e-mail address of the best point of contact who we can follow-up with about student applications:

First Name

Last Name

Nominee Information

Student First Name

Student Last Name

Student E-mail

If the student does not have a personal or school e-mail address, please enter the e-mail address of a guardian.

Student Gender

Guardian 1 First Name

Guardian 1 Last Name

Guardian 1 E-mail Address

Guardian 1 Cell Phone

Guardian 1 Preferred Language

Guardian 2 First Name

Guardian 2 Last Name

Guardian 2 E-mail Address

Guardian 2 Cell Phone

Guardian 2 Preferred Language

Report Cards

In our review of Part 1 Applications for BTNY, we will be checking to see if students have at least an 85% or above in their core classes (ELA, Math, Science, and Social Studies).

Do you currently have 6th grade progress reports or 6th grade report cards for your nominees?

YesNo

Please upload the progress report or report cards for your nominees below. If you need to upload more than one file, click the "Add another response" button below.

If you intend to nominate more than one (1) student please select "Add another response" below to continue adding nominees.

Next Steps

By clicking the "Submit" button below, you will be submitting nominations for BTNY. Following submission, our team will begin conducting direct email and phone outreach to your nominees, to encourage them to learn more and apply. Our team will also provide nominators with updates on the admissions status of their nominees.