2026-2027 BHOLC Application

2026-2027 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Withdrawn Date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
Date of Birth

MonthDayYear
Date
Grade Level
School District
School Name
Is this student on an IEP?
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)
Format: (000) 000-0000.
Parent/Guardian Name
First and Last Name
Your Relationship to Student
Other Relationship
Parent/Guardian Email
example@example.com
Primary Phone Number
Format: (000) 000-0000.
Secondary Phone Number
Format: (000) 000-0000.
Additional Contact Name
First and Last Name
Additional Contact's Relationship to Student
Additional Contact Phone Number
Format: (000) 000-0000.
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.
Learning Coach Mailing Address

Mailing Address

Street Address Line 2

City, State, ZipState / Province

Postal / Zip Code

Learning Coach's relationship to Student
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.Format: (000) 000-0000.

My student has a computer and high speed internet access
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
I will oversee and routinely check my child’s progress and will communicate with representatives of BHOLC.
I understand that lack of adequate progress can result in my student being removed from BHOLC
I understand that plagiarizing assignments will not be tolerated and may lead to withdrawal from BHOLC
I understand that BHOLC uses third-party curriculum and does not have a way to modify lessons
I acknowledge that my student must report to their school for state mandated testing in the spring
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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2026-2027 BHOLC Application

Learning Coach & Guardian Responsibilities