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

February Spotlight

In-Kind Support

Celebrating our "in kind" sponsors and advocates -- who support Mattie's Foundation with services and materials. Thank you ezStorage, Montgomery Printing, Parcel Plus, and Potomac Valley Brick! Read more...

Nourishment Support

Celebrating our "nourishment" sponsors and advocates -- who support Mattie's Foundation with food and services. Thank you Botanero Restaurant, Fontina Grille, Safeway, Coffee Republic, and Red Hot & Blue! Read more...

Community Support

Celebrating our "community" sponsors and advocates -- who support Mattie's Foundation with commitment and participation. Thank you City of Rockville, King Farm Citizen's Assembly, Kick's Karate & Mix 107.3! Read more...

Champion Support

Celebrating our "Foundation Champions" -- sponsors and volunteers of all ages who support Mattie's Foundation through donations, brick sponsorships, participation in our activities and events. Thank you!!! Read more...

- Mattie J.T. Stepanek