Submit a learning activity
L e a r n i n g  A c t i v i t y  F o r m

Answer all of the questions below and fill in all of the boxes, especially those with an asterisk (*). Your form will not be accepted if these fields are not completed. When you have finished, select the "submit" button to send your activity for review or click the "print" button with your browser to print out a copy of your learning activity.

[About Your Learning Activity] [About the Learners] [Your Learning Activity Plan]
[About the Facilitator] [Help with Learning Activity Form]

I. About Your Learning Activity HELP

*Title: HELP

If this activity is part of a larger project or unit, describe the project. HELP

*Write a one paragraph summary of your learning activity. You will be asked to describe your learning activity in detail in Section III, Your Learning Activity Plan. HELP

*What is the learning objective? HELP

*Skills (To enter multiple selections, hold down Ctrl or Apple key as you scroll and highlight) HELP

*Subjects (To enter multiple selections, hold down Ctrl or Apple key as you scroll and highlight)

Other subject terms -- optional (HELP WITH ALT):

*Approximately how long will the activity take? HELP


II. About the Learners

*At approximately what level are the learners for whom you designed the activity? HELP

This activity is suited for what type of instruction?

  • Individual
  • Small group
  • Whole class
  • Self-directed student work

III. Your Learning Activity Plan

Materials and Resources - What specific materials helped your learners to conduct the activity? (handouts, transparencies, Internet resources, equipment) HELP

*Overview - Please describe the setting or context in which you conducted this learning activity. HELP

*What learner needs and goals led you to this activity? HELP

*Describe the learning activity. HELP

*Assessment - What do learners know (content) and what are they able to do (skills) as a result of this activity? HELP

*Reflection - What would you do to change this activity next time? Describe how the skills learned in this activity were transferred to a real-life situation. HELP

IV. About the Facilitator

Please tell us something about you and your program.

*Your Name:

Email Address:

*Program Name:

*Type of Program:

Primary Student Population Served:

*Program Address:

*Program Phone:

Program Fax:

Web Site Address of Program (URL):


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