Lesson Plan / Unit Plan Teacher Submission Form General information not to be included on the nIc Foundation website Name: _______________________________________________ School District: ________________________________________ School Name: __________________________________________ Grade / Subject Level: ___________________________________ Email address: __________________________________________ Telephone: _____________________________________________ The following information will be included on the nIc Foundation website (List the name of the lesson plan / unit plan. Include a brief description) Submitted by: _____________________________________________ School District: ____________________________________________ School Name: ______________________________________________ City, State, zip code: ________________________________________ Recommended grade level(s): __________________________________ Positive Character Traits and Values addressed: ___________________ _________________________________________________________ Curriculum Connections: (check those areas that apply) □ Literature List book title(s) and author(s)____________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ □ Reading skills and strategies Name the skill / strategy ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ □ Writing What is the focus? ___________________________________________ ___________________________________________ ___________________________________________ □ Social Studies Name the standard ____________________________ ___________________________________________ ___________________________________________ □ Science Name the standard ____________________________ ___________________________________________ ___________________________________________ □ Math Name the standard ____________________________ ___________________________________________ ___________________________________________ ___________________________________________ □ Dance Name the standard ____________________________ ___________________________________________ ___________________________________________ □ Music Name the standard ____________________________ ___________________________________________ ___________________________________________ □ Art Name the standard ____________________________ ___________________________________________ ___________________________________________ □ Technology Name the standard ____________________________ ___________________________________________ ___________________________________________ Suggested Time Frame: ______________________________________ _________________________________________________________ _________________________________________________________ Special Equipment: __________________________________________ ________________________________________________________ _________________________________________________________ _________________________________________________________ Materials & Supplies: _______________________________________ ________________________________________________________ _________________________________________________________ _________________________________________________________ Special Comments: _________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ (Step-by-step Procedure for implementation of the plan) (Attach additional sheets if necessary) Assessment(s): _____________________________________________ ___________________________________________________________________________________________________________________________________________________________________________ Attachments: (Attach supportive documents including rubrics, study guides, hand-outs, matrixes, drill sheets, photos) Signature: _______________________________________________ Date: ___________________________________________________ All lesson plans / lesson units submitted become the property of the nIc Foundation and will not be returned. Submission of this lesson plan / unit form shall be deemed as acceptance of all guidelines and shall constitute assignment to the nIc Foundation any and all rights, title, and interest in and to the lesson plans / lesson units including all copyrights, all publishing rights, and all rights to reproduce, and otherwise use the lesson plans / unit plans and supporting documents in any and all formats or media. Please send lesson plans / unit plans to: nIc Foundation Teacher Page Attn: Lynn Marcks P.O. Box 218 Shawano, WI 54166-0218
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