Person currently submitting/reviewing this form:
Program Coordinator/Senior Mentor Liaison
Student Name
First Name Last Name
Student PFE ID#
Student Email
Current Grade Level
Total Number of Semesters Served in PFE (including this current semester)
School Name
School PFE Email
In which setting do you meet with your Senior Mentor?
In their own home
In a nursing home
In an assisted living facility
In a retirement community
Other option
Answer each question choosing either strongly agree, agree, unsure, disagree, or strongly agree.
Strongly Agree Agree Unsure Disagree Strongly
I am aware there are lonely, elderly people in my community.
My senior mentor and I enjoy each other's company.
My senior mentor and I learn from each other.
I do my best when I visit with my senior mentor.
I help make things easier for my senior mentor.
Being a part of the PFE program allows me to feel like I am helping others.
What do you enjoy most when you visit your senior mentor?
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Adventist Christian Academy of Raleigh, NC
Alcy SDA Junior Academy, TN (also Greater
Memphis Adventist Academy)
Andrews Christian Academy, IA
Asheville Pisgah Christian School, NC
Aspenwood Christian School, IA
Atlanta North School, GA
Avondale SDA School, TN
A.W. Spalding Elementary School, TN
Baker View Christian School, WA
Baltimore White Marsh Adventist School, MD
Bass Christian Elementary School, MS
Battle Creek Academy, MI
Beacon Academy, TN
Big Cove Christian Academy, AL
Blue Mountain SDA Elementary, PA
Bowman Hills School, TN
Cady Memorial School, NH
Caldwell Adventist Elementary, ID
Caledonia Christian School, VT
Captain Gilmer Christian School, NC
Carman Adventist School, GA
Cedar Lake Elementary, MI
Central Valley Christian School, OR
C.F. Richards Jr. Academy, VA
Chester River Adventist School, MD
Cochise SDA Christian School, AZ
College Park Christian Academy, MO
Collegedale Adventist Middle School, TN
Columbia Adventist Academy, SC
Cottage Grove Christian School, OR
Countryside Christian School, OR
Cypress Adventist School, WA
Deltona Adventist School, FL
Desert Adventist Academy, CA
Discover Christian School, NM
Douglasville SDA School, GA
Dover First Christian School, DE
Eddlemon Adventist School, SC
El Cajon Seventh-day Adventist Christian School,
E. L. Minnis Jr. Academy, KY
Escondido Adventist Academy, CA
F.H. Jenkins Preparatory School, TN
Five Oaks Adventist Christian School, NC
Floral Crest School, AL
Forest City Adventist School, FL
Forest Park Adventist Christian School, WA
Forestdale Christian School, ME
Frederick Adventist Academy, MD
Gateway Christian School, FL
Glenview Adventist Academy, AZ
Gold Coast Seventh-day Adventist Christian
School, OR
Golden Valley SDA School, MO
Grays Harbor Adventist Christian School, WA
Greater Miami Adventist Academy, FL
Greeneville Adventist Academy, TN
Gurnee Christian School, IL
Harrisburg Adventist School, PA
Hemet Adventist Christian School, CA
Higher Ground Mission Elementary School, NM
Highland Adventist School, WV
Highland Elementary School, TN
Hillcrest School, MO
Hillcrest SDA School, ND
Hinsdale Adventist Academy, IL
HMS Richards Adventist School, CO
Hood View Junior Academy, OR
Huntingdon Valley Christian Academy, PA
Jellico Christian Academy, TN
John L. Coble Elementary, GA
Kirkland SDA School, WA
La Sierra Academy, CA
Laguna Niguel Jr. Academy, CA
Lake Nelson SDA School, NJ
Learning Tree Elementary School, GA
Lehigh Valley Seventh-day Adventist Elementary
School, PA
Lester Coon Adventist School, TN
Lewis County Adventist School, WA
Lithonia Adventist Academy, GA
Living Springs Christian Academy, TN
Loma Linda Academy, CA
Louisville Adventist Academy, KY
Madison Campus Elementary, TN
Madrone Adventist Elementary School, OR
Manassas Adventist Preparatory School, VA
Meadow Glade Adventist Elementary School, WA
Meadow View Junior Academy, NJ
Midland Adventist Academy, KS
Mile High Academy, CO
Mills River SDA School, NC
Miramonte Christian School, CA
Mobile Junior Academy, AL
Mt. Aetna Adventist School, MD
Murrietta Springs Adventist Christian Academy,
Nashville Christian Advancement Academy, TN
Needles Adventist School, CA
North Shore Adventist Academy, IL
North Star Christian School, ME
Northwest Christian School, WA
Northwoods Elementary School, MN
Oceanside Adventist Elementary, CA
Olympia Christian School, WA
Ooltewah Adventist Christian School (OAKS), TN
Ozark Adventist School, AR
Pine Tree Academy, ME
Poulsbo Adventist School, WA
Reading Junior Academy, PA
Redlands Adventist Academy, CA
Richmond Academy, VA
Riverside Christian School, WA
Riverview Memorial School, ME
Roanoke Adventist Preparatory School, VA
Rocky Knoll School, WV
Rogue Valley Adventist Academy, OR
Ruth Murdoch Elementary School, MI
Saguaro Hills Seventh-day Adventist Christian
School, AZ
San Antonio Christian School, CA
San Diego Academy, CA
Savannah Adventist Christian School, GA
Sawgrass Adventist School, FL
Scappoose Adventist School, OR
Sedalia SDA School, MO
Shady Point Seventh-day Adventist Elementary
School, OR
Shenandoah Valley Adventist Elementary School,
Sheridan Adventist Elementary School, IL
Shoreline Christian School, OR
Skagit Adventist Academy, WA
Spring Valley Academy, OH
Springfield SDA Junior Academy, MO
Springs Adventist Academy, CO
Standifer Gap SDA School, TN
Stanley Seventh-day Adventist School, VA
Summit View Adventist School, MO
Sunnydale Adventist Elementary, MO
Sunshine Christian School, CO
Tappahannock Junior Academy, VA
Taylor Mill Christian Academy, KY
Three Sisters Adventist Christian School, OR
Tidewater Adventist Academy, VA
Tree of Life Christian Preparatory School, VA
Tryon SDA School, NC
University SDA School, TN
Upward Adventist School, NC
Valdosta Christian School, GA
Valley Adventist Christian School, CA
Vienna Adventist Academy, VA
Vine Haven Adventist School, NJ
Vista Ridge Academy, CO
Waldwick Adventist School, NJ
Westwood Adventist Junior Academy, MO
Wimbish Adventist School, GA
Worland Adventist Christian School, WY
Worthington Adventist Academy, OH
Wyoming Valley School, PA
TEST ACADEMY (do not choose)
What do you think your senior mentor enjoys most about your visits?
What is something you have learned from your senior mentor?
What is something you have taught your senior mentor?
Please answer the following questions as honestly as possible.
Agree Unsure Disagree Strongly
Getting started in the PFE program was uncomplicated.
I felt supported by the school while involved in the PFE program.
I enjoyed performing visits with my child.
I know someone at the school to ask about any questions about the PFE program.
The school's orientation prepared me and my child to participate in the PFE program.
I appreciate the opportunity my child has to improve their senior mentor's daily living
and quality of life.
The PFE program encourages my child to empathize wiht others' feelings and be
cooperative, generous, and kind.
The PFE tuition assistance my child receives makes this school affordable.
I would recommend the PFE program to other families.
If you answered "disagree" or "strongly disagree" to any of the questions above, please explain here:
Additional Comments:
Program Coordinator/SM Liaison Password
Please answer the following questions as truthfully and accurately as possible:
Always Frequently Sometimes Seldom Never N/A
This student submits their online reflections on time.
This student represents the school well.
The student has positive things to say about his/her experiences in the PFE
This student demonstrates a genuine care for his/her senior mentor.
Please include any other feedback or information, including any praises or concerns pertaining to this
student's participation in PFE:
Please answer the following questions as truthfully and accurately as possible:
Always Frequently Sometimes Seldom Never
My student is engaged with me when he/she is visiting.
My student takes initiative.
My student is thougtful and considerate.
Would you say you have developed a personal relationship with your student?
What are some of the activities you and your student do together?
What have you and your student learned from each other?
What do you appreciate most about your student?
How could your student improve or what are some of the positive changes you have seen in your student?
Did a representative from the school visit you to explain the expectations of the visit?
Would you like to provide any additional comments?
What is the status of this performance review?
Still in Progress
All Sections are Finished
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