Peace Activity Certificate Tool
Peace Activity Certificate Tool (PACT)
This is a suggested template.
Please modify/expand as appropriate.
Lesson or Activity Plan Title:
Are you Peace Certification Program Participant(s) (yes___ no___)
Season ___________ Year ___________
Is the plan related to an outreach activity created by Mattie’s Foundation?
(yes ______ no _______) (If yes, which one: _____________________)
Name of Educator or Individual:
Name of Individual, Leader, or Group:
Your role (e.g., teacher, counselor, parent, librarian…):
Name of community/group/school:
Location (city, state, country):
Subject /content area(s):
How is this lesson related to Mattie’s poetry or peace message
—– (e.g., which poem, quote, book, etc):
Recommended age/grades/developmental level:
Who created or adapted this plan:
Activity or Lesson Objectives:
Relationship to State Standards (if applicable):
Length of activity (minutes, days, weeks…):
Number of students/classes impacted:
Preparation steps before lesson/activity:
Modifications (for students with disabilities, ESL …)
Please describe how the activity or lesson was introduced and carried out.
- What was said and done first, next…
- Specific steps in the lesson/activity…
- Discussion questions and extension activities…
- Closure or follow-up discussion or activities…
- Any evaluation of the lesson/activity (what/who/how)…
Please describe participant reflections and responses to the lesson/activity:
- What did they like? What would they change?
- What did they learn? Do they want to learn more?
Is this an activity or lesson that families or other groups/classrooms also learned about or were involved with?
Describe your thoughts on “What Next?” (for the students, for this activity…):
Please describe any suggestions for replication (including modifications):
Other comments or feedback…
Please include sample photos (artwork, photos of essays, students in action, bulletin boards, etc…)
Please return this form/information and photos to
402 King Farm Blvd. #125, Rockville, MD 20850