Break Through TechUndergraduate Student Interest Form

Break Through Tech equips aspiring technologists with the technical skills, work-based learning experiences and professional readiness support to break into tech roles.

Our programs are open to undergraduate students who are currently enrolled in good academic standing in a 2- or 4-year degree program at a US-based institution.

To express your interest in being considered for enrollment, please complete our Interest Form. By doing so, you will be subscribed to our Interested Student Newsletter, and you will be notified by a member of our team if any opportunities arise that match your interests.

For any questions or concerns, please visit our Help Center.

Please note: In submitting this form you acknowledge that your information will be used solely for the purpose stated in the Privacy Policy and may be shared with the third parties referenced in the Privacy Policy.

-----------------------------------------------------------------------------------------------------------------

About You

First Name

Preferred First Name

Last Name

Pronouns

Please specify:

Primary Email

Alternate Email

Mobile Phone Number

Street Address

Please provide your permanent U.S. address (where you reside when school is not in session. If not applicable, please put your school address)

City

State

Zip Code

Please share a link to your GitHub profile (OPTIONAL)

Please share a link to your professional portfolio (OPTIONAL)

Are you currently enrolled in an associates (2-year) or bachelors (4-year) degree program at an accredited college or university in the United States?

YesNo

Page 2

About Your Education and Experience

What college or university do you attend?

Can't find your college or university in this list?
Don’t see your institution? Visit our Help Center

University ID (List 1)

What is your major (or intended major)?

If your major is unrelated to the listed options, please select "Other"

What is your minor (or intended minor)?

If your minor is unrelated to the listed options, please select "Other."

If "Other", please specify

When do you expect to complete your degree?

Will you be actively searching for an internship or full-time job in tech or AI within the next year?

Are you an international student?

Cumulative GPA (on a 4.0 scale)

Would you like to attend a virtual information session to hear more from Break Through Tech staff, fellows and alumni about our programs?

YesNo

How did you hear about Break Through Tech?

If you selected "Other", please specify.

If you heard about Break Through Tech through a club or organization, please select which one below:

If you selected "Other", please specify which club or organization.

If you were referred by a friend, colleague, professor or other person you know, share their name below.

Page 3

Demographic Details

The following questions are optional and do not affect your eligibility for our programs.

What is your gender?

Prefer to self-describe; please specify

Which racial or ethnic group do you identify with?

Select all that apply. Hold CTRL to select more than one option

Are you eligible for, or have you ever received, a Pell Grant?

To be eligible for a Pell Grant, you must be eligible for federal financial aid and demonstrate additional financial need.

Have either of your parents or your guardian completed a college degree in the United States (e.g. Technical, Associates, Bachelors)?