2025-2026 BHOLC Application

2025-2026 BHOLC Application
Website: www.bholc.org email: bholc@bhssc.org

Phone: 605.721.4506 or 605.394.1876
School Year
Enrollment Status
Approved Date

MonthDayYear
Date
Withdrawn Date

MonthDayYear
Date
Student Name*
First and Last Name
Gender*

MaleFemalePrefer not to say
Date of Birth*

MonthDayYear
Date
Grade Level*
School District*
School Name*
Is this student on an IEP?*

YesNo
Please note our virtual learning programs do not make accommodations for students on IEPs.
IEP?
Student Email Address (Grades 6-12)*
example@example.com
Student Phone (Grades 6-12)*
Parent/Guardian Name*
First and Last Name
Your Relationship to Student*
Other Relationship*
Parent/Guardian Email*
example@example.com
Primary Phone Number*
Secondary Phone Number
Additional Contact Name*
First and Last Name
Additional Contact's Relationship to Student*
Additional Contact Phone Number*
Additional Contact Email Address*
example@example.com
Learning Coach & Guardian Responsibilities

BHOLC requires that each full-time student has a designated adult who will have the primary responsibility of being actively involved in all school-related work and activities. This adult will have a learning coach account and will be the primary point of contact for BHOLC and Learning Facilitators. You can choose to select someone other than yourself as the learning coach, however, please note that Legal Guardians are still primarily responsible for ensuring school policies are followed.The Legal Guardian/Learning Coach will:

• Actively monitor, assist, and motivate the student on a daily basis to ensure academic progress and adherence.

• Help the student stay on task and ensure the student is following through on his or her assignments while the student is expected to manage his or her own time and schedule directly.
I am appointing someone other than myself as the Learning Coach for my student.*

YesNo
Learning Coach Mailing Address*

Mailing Address

Street Address Line 2

City, State, ZipState / Province

Postal / Zip Code

Learning Coach's relationship to Student*

MotherFatherGuardianGrandmotherGrandfatherOther
Learning Coach's Other Relationship*
Learning Coach Name*

First NameLast Name
Learning Coach Email*
example@example.com
Learning Coach Phone Number*
Please enter a valid phone number.

My student has a computer and high speed internet access*

Yes
I acknowledge that I will be the Learning Coach or will appoint a learning coach for my student. I understand that active participation is required by me. I will oversee and routinely check my student's progress and will communicate with representatives of BHOLC*

Yes
I will oversee and routinely check my child’s progress and will communicate with representatives of BHOLC.*

Yes
I understand that lack of adequate progress can result in my student being removed from BHOLC*

Yes
I understand that plagiarizing assignments will not be tolerated and may lead to withdrawal from BHOLC*

Yes
I understand that BHOLC uses third-party curriculum and does not have a way to modify lessons*

Yes
I acknowledge that my student must report to their school for state mandated testing in the spring*

Yes
By typing my signature here, I certify that I am a parent/guardian for the student named above and am requesting my student to participate in Black Hills Online Community. I understand that enrollment must be approved by an authorized district administrator.*
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2025-2026 BHOLC Application

Learning Coach & Guardian Responsibilities