Student Name: Date: Title/Topic:    Age or grade: 

This activity meets the following Indiana Academic Foundation standards:

Reading: 

Math : 

Science: 

Social Studies: 

Physical  Ed.: 

Music: 

Visual Arts: 

Bloom’s Taxonomy   ______ Knowledge ______ Comprehension ______ Application ______ Analysis ______ Synthesis ______ Evaluation  Learning Styles/Domains   _____ Visual – Spatial _____ Bodily – Kinesthetic _____ Auditory – Musical _____ Interpersonal _____ Intrapersonal _____ Verbal – Linguistic _____ Logical – Mathematical ______ Naturalistic ______ Existential  
Instructional Goal (outcome that students should be able to demonstrate upon completion of the learning experience, should be related to state standards or Indiana Foundations)
Performance Objective (use an action verb in a description of a measurable outcomes    
Materials & Aids (what you will need in order to teach this activity):  
Procedures: Focusing event (how you will begin the lesson and attract the children’s attention):               Student Participation (how you will get the students to participate and stay on task): Teaching procedures (step-by-step directions for what and how you will teach): Closure (how you will end the learning activity):                
Assessment Formative check (progress checks throughout the learning activity): Summative assessment (how you will measure outcomes to determine if the material has been learned):      
Adaptations for special needs (based on IFSP or IEP):        
Lesson Extensions For More Practice:           For More Challenge:                  

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