Event Interest Form
Hidden Fields
Family Member Record Type Id
Scholar Record Type Id
Which best describes you?
My child is NOT currently enrolled at a Breakthrough school.
My child is currently enrolled at a Breakthrough school and I am interested in enrolling additional children/siblings.
I am a parent or guardian with a currently enrolled scholar at Breakthrough Public Schools and NOT interested in enrolling a sibling.
Enrollment Event You Would Like To Attend
Select
Selected
Date
Event
Count
Family Information
Parent/Guardian First Name
Parent/Guardian Last Name
Email Address
Phone Number
Phone or Email
Please provide either an email address, a phone number, or both
Home Address
Street
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Zip Code
Preferred Method of Contact
Email
Text
Both Email and Text
Preferred Language for Communication
Please select...
English
Spanish
French
Chinese
Scholar Information
To add multiple scholars, click 'Add Another Scholar' at the end of this section
Scholar First Name
Scholar Last Name
Scholar Date of Birth
Grade Interested In
Please select...
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
School Year of Interest
(e.g., 2026–27)
Recruitment Year Id (Hidden)
Which campus(es) are you interested in?
Glenville Campus, K-8 (Glenville)
Midtown Campus, K-8 (St. Clair - Superior)
Southeast Campus, K-8 (Lee-Harvard)
Willard Campus, K-8 (W 95th & I-90)
Woodland Hills Campus, K-8 (Union Miles)
How did you hear about us?
Friend/Family
Current Family
Daycare/Childcare Provider
Community Organization
Social Media
Website/Online Search
Mailing
Radio
Other
Other:
Please select at least one event and provide at least one form of contact information
Contact Information