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

January Spotlight

May 5 at Botanero

Cinco de Mayo Partnership Fiesta - FREE ENTRY - All Day Happy Hour & food specials, Music by DJ Genius, ZamDance performances -- join us for a fundraising party that celebrates peace and acceptance! Read more...

June 2 at Dawson's

Mosaics & Music: Make Peace the News -- join us for wine & apps, music & mosaic unveiling, conversation & celebration at a fundraising gathering to promote peace! Early Bird Tickets $25 ($30 at the door). Read more...

June 21 and 22

Celebrating Mattie’s life & legacy – 15-year anniversary Mass on June 22 (11 am) at St. Francis of Assisi Church in Derwood, MD, followed by a reception hosted by Mattie's Guild - ALL ARE WELCOME. Read more...

July 13 in King Farm

2019 Peace Day Celebration – join us for a FREE street fair (1-5 pm), all day food & drink specials (1-8 pm), and a Happy Hour Dance Party (5-8 pm) – arts, crafts, music, performers, cake, moon bounce… Read more...

- Mattie J.T. Stepanek