2016-2017 ASSIST Student Performance Review Instructions
for Student Supervisors
How to Complete Your Portions
Please read before attempting to have your students and parents complete their performance
reviews:
There are four sections to the 2016-17 PFE Student Performance reviewthe student’s
section, the Program Administrator or Student Supervisors section, the Facility
Administrators and the Senior Mentor’s section. Please distribute the instructions for students
before they fill anything out. Once the student portion is submitted, they will receive a
confirmation email and you will receive a notification email. In your notification email, there will
be a link to access their portion of the review.
It will be helpful to have the questions for the Facility Administrator and Senior Mentor
sections ahead of time so that the Senior Mentor Liaison and Student Supervisor may conduct
interviews to obtain the answers before this review is completed. They are attached to the end
of these instructions.
For your knowledge, the link to the performance review is on the front page of our
website, www.southern.edu/assistpfe, and is in the ASSIST Academy Students section above
the application and visitation reflection links (see snapshot below)
STEP #1
1. When a student completes their portion of the performance review, you will receive an
email that looks like the picture below, with “[Student’s} 2016-17 PFE Student
Performance Review Has Been Submitted”.
2. Click on the link that says “Edit Submission”. You also have the option of downloading a
PDF of the student’s responses before you complete the rest of the review.
STEP #2
1. The student’s performance review will open. Switch the “Person currently
submitting/reviewing this form” to “Program Administrator/Student Supervisor.
2. Review the student’s information, making sure all is correct; but be sure to leave the
student’s candid answers untouched.
3. Click “Next”.
STEP #3
1. You will be taken to a page that asks for a “Program Administrator Password. Use the
same password that you use to approve visitation reflections. This should be formatted
as “assist*[schoolname]” to access the “Program Administrator or Student Supervisor
Feedback Section”. I entered in assist*sau” to illustrateyou must enter in at least the
assist*” portion to access the next sections.
2. The Program Administrator or Student Supervisor Feedback Sectionwill come up. Fill
in your answers then click “Next”.
STEP #4
1. Next is the Facility Administrator Feedback Section. You will need to have conducted
an interview with or given your students facility administrator the questions to fill out
before this section can be completed online. Please fill in this persons answers honestly
and candidly. You may always go back through the link you receive in your email to fill in
this persons answers. The questions for this sections are attached.
2. When you are finished, click Next.
STEP #5
1. You will see the “Senior Mentor Feedback Section” next. You will need to fill in the
answers that the student’s senior mentor has given during their interview (questions are
attached). Please fill this section in honestly and candidly.
2. We have included two additional Senior Mentor Feedback Sections in case the
student has multiple senior mentors. If he/she has more than three, you are only
required to obtain answers from three individuals.
3. If you need to add a senior mentors answers, select Yes to the Do you have another
senior mentors feedback to add? question.
4. When you are finished, click Next.
STEP #6
1. The last page will ask you, “What is the status of this performance review?” We have
created the review in such a way that if you need to go back to enter in any information
in any section, particularly the Facility Administrators or Senior Mentor’s, then you may
select “Still in Progress”. If you have collected all of your information ahead of time and
have entered it all in, select “All Sections are Finished” to notify us of the review’s
completion.
2. After you have selected
the status, click
“Submit”. If you
submitted the review as
Still in Progress, be
sure to go back,
complete it, and submit
again as All Sections
are Finished.
3. On the Thank You page, you will have the option of going back into the review to edit or
download a PDF of your completed review. We suggest downloading PDFs when the
reviews are finished for the benefit of your program. These reviews are beneficial in
growing your program, making changes, and giving out praise/thanks where merited.
You are finished!
Facility Administrator Feedback Section
Questions for Interview
1. This student is engaged with his/her senior mentor(s) (choose one):
a. Always
b. Frequently
c. Sometimes
d. Seldom
e. Never
2. This student and his/her senior mentor(s) interact and learn from each other (choose one):
a. Always
b. Frequently
c. Sometimes
d. Seldom
e. Never
3. This student is aware of the needs of his/her senior mentor(s) (choose one):
a. Always
b. Frequently
c. Sometimes
d. Seldom
e. Never
4. This student is an advocate for his/her senior mentor(s) (choose one):
a. Always
b. Frequently
c. Sometimes
d. Seldom
e. Never
5. This student is respectful and considerate of staff members (choose one):
a. Always
b. Frequently
c. Sometimes
d. Seldom
e. Never
6. This student engages in one-to-one activities with his/her senior mentor over group activities (choose
one):
a. Always
b. Frequently
c. Sometimes
d. Seldom
e. Never
7. Would you like to provide any additional comments? (short answer)
Senior Mentor Feedback Section
Questions for Interview
1. My student mentee is engaged with me when he/she is visiting (choose one):
a. Always
b. Frequently
c. Sometimes
d. Seldom
e. Never
2. My student mentee takes initiative (choose one):
a. Always
b. Frequently
c. Sometimes
d. Seldom
e. Never
3. My student mentee is thoughtful and considerate (choose one):
a. Always
b. Frequently
c. Sometimes
d. Seldom
e. Never
4. Would you say you have developed a personal relationship with your student?
a. Yes
b. No
5. What are some of the activities you and your student do together? (short answer)
6. What are some things your student does for you? (short answer)
7. What do you appreciate most about your student? (short answer)
8. Did a representative from the school visit you to explain the expectations of the visits? (short answer)
9. Would you like to discuss any areas your student could improve or additional comments? (short answer)
Person currently submitting/reviewing this form:
Student
Program Administrator/Student Supervisor
Student Name
First Name Last Name
Student ASSIST ID#
Student Email
Current Grade Level
EXAMPLE
THIS EXAMPLE IS NOT TO BE USED TO TURN IN, HARD COPY, TO
SOUTHERN'S PFE OFFICE. USE THE ONLINE FORM. THANK YOU.
-
Grade 9
Grade 10
Grade 11
Grade 12
Number of Semesters Worked in ASSIST (including the current semester)
Academy Name
Academy ASSIST Email
In each of the settings listed below, indicate how many senior mentors you were partnered with:
1 2 3 4 5 6+
Nursing Home
Individual Residence
Assisted Living Facility
Retirement Community
Other
Please answer each of the below questions, indicating either Strongly Agree, Agree, Unsure, Disagree, or
Strongly Agree:
Strongly
Agree
Agree Unsure Disagree Strongly
Disagree
I am aware senior citizens in my community are in need of company.
I know what is expected of me when I am working with my senior mentors.
The online reflection profess is easy to understand.
I typically receive approved or denied feedback within two days of submitting my
reflections.
My senior mentor(s) and I enjoy each other's company.
My senior mentor(s) and I learn from each other.
I am making a positive impact with the senior mentor(s) I am partnered with.
I am meeting a need in the community.
Without this job I would most likely not be able to attend my school or academy.
The mission or purpose of the ASSIST Program makes me feel my job is
important.
EXAMPLE
-
Andrews Academy, MI
Atlanta Adventist
Academy, GA
Bass Memorial
Academy, MS
Battle Creek Academy,
MI
Blue Mountain
Academy, PA
Campion Academy, CO
Collegedale Academy,
TN
Columbia Adventist
Academy, WA
Fletcher Academy, NC
Gem State Adventist
Academy, ID
Georgia-Cumberland
Academy, GA
Great Lakes Adventist
Academy, MI
Greater Atlanta
Adventist Academy, GA
Greater Miami
Adventist Academy, FL
Greeneville Academy,
TN
Gurnee Christian
School, IL
Higher Ground Mission
School, NM
Highland Academy, TN
Highland Adventist
School, WV
Highland View
Academy, MD
Hinsdale Adventist
Academy, IL
Indiana Academy, IN
Jefferson Christian
Academy, TX
Madison Academy, TN
Maplewood Academy,
MN
Midland Adventist
Academy, KS
Mile High Academy, CO
Milo Adventist
Academy, WA
Mount Ellis Academy,
MT
Mount Pisgah Academy,
NC
Ozark Adventist
Academy, AR
Pine Forge Academy,
PA
Pine Tree Academy, ME
Portland Adventist
Academy, OR
Puget Sound Adventist
Academy, WA
Richmond Academy, VA
Rio Lindo Adventist
Academy, CA
Riverview Memorial
School, ME
Rogue Valley Adventist
Academy, OR
Savannah Adventist
Christian School, GA
Shenandoah Valley
Academy, VA
Skagit Adventist
Academy, WA
Spring Valley Academy,
OH
Takoma Academy, MD
Upper Columbia
Academy, WA
Vienna Adventist
Academy, VA
Vine Haven Adventist
School, NJ
TEST ACADEMY (do
not choose)
What have you learned from visiting with your senior mentor?
What is one (or more) area in which you could improve on regarding your work in the ASSIST Program?
Do you think you would be interested in a career working in the senior care industry? Examples: Working
as a nurse, activities director, nursing home/assisted living manager, or other job in which seniors live.
Yes
No
Is there anything you would like to say to the people who fund the ASSIST Program?
Do you have any suggestions, experiences, or thoughts you would like to let us know about?
EXAMPLE
Program Administrator Password
Please answer the following questions as truthfully and accurately as possible:
Always Frequently Sometimes Seldom Never N/A
This student shows up for work on time.
This student takes initiative and is engaged with their senior mentor.
This student represents the school well.
This student is committed to interacting and learning from their senior
mentor.
This student demonstrates a genuine care for his/her senior mentor.
This student submits their visitation reflections on-time.
Please include any other feedback or information, including any praises or concerns pertaining to this
student's work in ASSIST:
EXAMPLE
Submit
Please answer the following questions as truthfully and accurately as possible:
Always
Frequently Sometimes Seldom Never
This students is engaged with the senior mentor(s).
This student and his/her senior mentor(s) interact and learn from each other.
This student is aware of the needs of his/her senior mentor(s).
This student is an advocate for his/her senior mentor(s).
This student is respectful and considerate of staff members.
This student engages in one-to-one activities with his/her senior mentor over group
activities.
Would you like to provide any additional comments?
Please answer the following questions as truthfully and accurately as possible:
Always Frequently Sometimes Seldom Never
My student mentee is engaged with me when he/she is visiting.
My students mentee takes initiative.
My student mentee is thougtful and considerate.
Would you say you have developed a personal relationship with your student?
Yes
No
EXAMPLE
What are some of the activities you and your student do together?
What are some things your student does for you?
What do you appreciate most about your student?
Did a representative from the school visit you to explain the expectations of the visit?
Yes
No
Would you like to discuss any areas your student could improve or additional comments?
Do you have another senior mentor's feedback to add?
Yes
No
Please answer the following questions as truthfully and accurately as possible:
AlwaysFrequentlySometimesSeldomNeverMy student mentee is engaged with me when he/she is visiting.My students mentee takes initiative.My student mentee is thougtful and considerate.
Would you say you have developed a personal relationship with your student?
YesNo
What are some of the activities you and your student do together?What are some things your student does for you?What do you appreciate most about your student?Did a representative from the school visit you to explain the expectations of the visit?
YesNo
Would you like to discuss any areas your student could improve or additional comments?Do you have another senior mentor's feedback to add?
YesNo
Please answer the following questions as truthfully and accurately as possible:
AlwaysFrequentlySometimesSeldomNeverMy student mentee is engaged with me when he/she is visiting.My students mentee takes initiative.My student mentee is thougtful and considerate.
Would you say you have developed a personal relationship with your student?
YesNo
What are some of the activities you and your student do together?What are some things your student does for you?What do you appreciate most about your student?Did a representative from the school visit you to explain the expectations of the visit?
YesNo
Would you like to discuss any areas your student could improve or additional comments?
What is the status of this performance review?
Still in Progress
All Sections are Finished
EXAMPLE
Powered by TCPDF (www.tcpdf.org)
EXAMPLE
Submit