Break Through Tech AI Interest Form

Thank you for your interest in Break Through Tech AI! Please complete this interest form to receive more information about the next available program offering. The AI Program runs annually from May-April, and applications open in December of each year. Visit the AI Program page for more information about program components and eligibility requirements.

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.

PERSONAL INFORMATION

Primary Email

Alternate Email

First Name

Preferred First Name

Last Name

EDUCATION

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?

What college or university do you attend?

University ID (List 1)

University Region

My college/university isn't in this list.

What college or university do you attend? (LIST 2)

University Name (List 2)

University ID (List 2)

University Region

MSI/PWI

University Type

Governance Type

University url

University Mailing City

University Mailing State

University Mailing Zip Code

Current degree program

Will you be transferring to a bachelors (4-year) degree program by Fall 2025?

When do you expect to complete your bachelors (4-year) degree?

Graduate students and undergraduate seniors (4th years) are not eligible to apply. Associate's (2-year) degree students are eligible to apply if they intend to transfer to a bachelor's degree program after completing their associate's degree.

What is your major (or intended major)? If your major is unrelated to the listed options, please select "Other."

If "Other", please specify

Do you have a second major?

YesNo

What is your second major? If your second major is unrelated to the listed options, select "Other."

If "Other", please specify

Do you have a minor?

YesNo

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

If "Other", please specify

Contact Information