School Administrator Recommendation Form

[To be completed by School Counselor, Dean of Students, Vice-Principal, or Principal.]

Dear School Administrator:

The student above is applying to Breakthrough of Greater Philadelphia – a tuition-free, academic enrichment program held at Germantown Friends School, Grover Washington Jr. Middle School, and St. Joseph’s University. The program seeks motivated sixth-grade students to participate in its six-year program consisting of two, six-week summer sessions (after the 6th and 7th grades) with year-round tutoring and advising, and high school support. Breakthrough is committed to serving a diverse student body representing the variety of ethnic and economic backgrounds in the North, Northwest & West Region of Philadelphia.

Please note that in January Breakthrough will fax you forms signed by parents/guardians of student applicants for the release of student records.

We would appreciate your candid responses, which will be kept confidential. If you have any questions regarding the program, please call the Breakthrough office: (215) 951-2398.

Thank you,

Breakthrough of Greater Philadelphia

Applicant's Information

Student's Name: *

School/University: *

Grade: *

Your Information

Name: *

Title: *

Reference

Do you know of any special interests, talents, or abilities that this applicant possesses which would be helpful for us to know about?: *

How would Breakthrough particularly benefit this student? What might this student bring to Breakthrough?: *

What makes this student distinct from the other students at your school?: *

Please describe parental/guardian involvement with this student's education.: *

Do this student's records indicate exemplary attendance, behavior, or dedication to the school community? Please explain.:

Does this student participate in special programming such as the Mentally Gifted Program or District Chorus? Does this student have any special Behavior Modification Programs or an IEP? Please explain.:

Is there anything else we should know about this student's skills, family situation, behavior, etc.?:

Please list your reservations.:

School Administrator Recommendation Form

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