Peace Activity Certificate Tool

Posted on: December 21st, 2014 by jeni No Comments

Peace Activity Certificate Tool (PACT)

This is a suggested template.

Please modify/expand as appropriate.

You may download the PDF version 
by clicking here…


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):

Materials needed:

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



Return to Peace Tips & Poetry Links main page


Return to Peace Certification Program main page


Return to Teacher Tips & Lesson Plans main page

November Spotlight

Peace Seeker

Our Peace Seeker Spotlights honor our Peace Club Youth members -- and the families, educators, and mentors who choose to support these Kids, Tweens, and Teens in learning and celebrating that “peace is possible.” Read more...

Peace Maker

Our Peace Maker Spotlights honor our Peace Club General & VIP members – adults who "choose peace" and offer a small membership fee that supports our activities and programs, including the free activities offered to our youth members. Read more...

Peace Bringer

Our Peace Bringer Spotlights honor our Peace Activity Certificate and Peace Certification Program participants – individuals, families, educators, schools, communities, and more who choose to move from “attitude to action” with peace. Read more...

Peace Sponsor

Our Peace Sponsor Spotlights honor our Champions, Advocates, and Program Messengers – individuals, organizations, and businesses whose financial or in-kind contributions support the mission and work of Mattie’s Foundation. Read more...

- Mattie J.T. Stepanek