York Public Schools Social Studies Fifth Grade Revised NEEDED FO R DATES TAUGHT DATE ASSESSED MASTERY # OF DAYS

Similar documents
5th Grade Unit Plan Social Studies Comparing the Colonies. Created by: Kylie Daniels

Kindergarten Foundations of America

FOR TEACHERS ONLY RATING GUIDE BOOKLET 1 OBJECTIVE AND CONSTRUCTED RESPONSE JUNE 1 2, 2005

Course Description: Technology:

Preparing for Permanent Residency and Citizenship

Sectionalism Prior to the Civil War

Lesson Set. Lesson Title Teacher Janet Moody Grade Level 4th Duration of Lesson 4 days

MATERIAL COVERED: TEXTBOOK: NOTEBOOK: EVALUATION: This course is divided into five main sections:

Globalization and the Columbian Exchange

Indiana Bonus #2. Prentice Hall Grades 6 & 7 Free Teacher Print Resources Per classroom teacher with a minimum purchase of 50 Student Editions

LESSON TITLE: The Road to Writing Perfect Paragraphs: Follow The Old Red Trail

UNITED STATES SOCIAL HISTORY: CULTURAL PLURALISM IN AMERICA El Camino College - History 32 Spring 2009 Dr. Christina Gold

Curriculum Scavenger Hunt

Grade Band: High School Unit 1 Unit Target: Government Unit Topic: The Constitution and Me. What Is the Constitution? The United States Government

Asia s Global Influence. The focus of this lesson plan is on the sites and attractions of Hong Kong.

History. 344 History. Program Student Learning Outcomes. Faculty and Offices. Degrees Awarded. A.A. Degree: History. College Requirements

THE APPROVED LIST OF HUMANITIES-SOCIAL SCIENCES COURSES FOR ENGINEERING DEGREES

Extended Common Core Social Studies Lesson Plan Template

Create A City: An Urban Planning Exercise Students learn the process of planning a community, while reinforcing their writing and speaking skills.

United states panel on climate change. memorandum

Digital Path. Here is a look at the organization and features of the program. After logging in, click Pearson Content on the Programs channel.

Yabisi Santillana Social Studies 5

Writing for the AP U.S. History Exam

Middle School Curriculum Guide

Will Rogers College Junior High School

LOUISIANA HIGH SCHOOL RALLY ASSOCIATION

Unit Lesson Plan: Native Americans 4th grade (SS and ELA)

Language. Name: Period: Date: Unit 3. Cultural Geography

HISTORY 108: United States History: The American Indian Experience Course Syllabus, Spring 2016 Section 2384

Florida Reading for College Success

TASK 1: PLANNING FOR INSTRUCTION AND ASSESSMENT


MINISTRY OF EDUCATION

520 HISTORY.ORG CIVICS HOW DO PEOPLE WORK TOGETHER TO SOLVE PROBLEMS?

Prentice Hall Chemistry Test Answer Key

Chapter 4 Culture & Currents of Thought

Bridgette O Connor - Semester with block scheduling

2016/17 Big History: Sample Semester-Long Course Plan Content Pacing Guide

Hist 1210, World History 1 Spring 2013, Tuesday and Thursday 9:40-11:05am (01)

The lasting impact of the Great Depression

Russell M. Rhine. Education

This map-tastic middle-grade story from Andrew Clements gives the phrase uncharted territory a whole new meaning!

EXPANSION PACKET Revision: 2015

University of New Orleans

ARSENAL OF DEMOCRACY

Imperial Avenue Holbrook High. Imperial Valley College. Political Science 102. American Government & Politics. Syllabus-Summer 2017

Political Science Department Program Learning Outcomes

Name of Course: French 1 Middle School. Grade Level(s): 7 and 8 (half each) Unit 1

Renae Townsend G21 PBL Project

MASTER SYLLABUS. Course Title: History of American Art Course Number: 1045

1. Locate and describe major physical features and analyze how they influenced cultures/civilizations studied.

Rubric For California Mission Project

eportfolio Guide Missouri State University

How to Prepare for the Growing Price Tag

Agricultural Production, Business, and Trade in Spain and France ECON 496

INTRODUCTION TO TEACHING GUIDE

Lesson #1: Mapping the Nation s Capitol Name: Sarah Faszewski Cooperating Teacher: Dormire School: Magruder Elementary Audience: Primary (1st Grade)

Making Sales Calls. Watertown High School, Watertown, Massachusetts. 1 hour, 4 5 days per week

The Federal Reserve Bank of New York

FINN FINANCIAL MANAGEMENT Spring 2014

EMPLOYMENT APPLICATION Legislative Counsel Bureau and Nevada Legislature 401 S. Carson Street Carson City, NV Equal Opportunity Employer

Text: envisionmath by Scott Foresman Addison Wesley. Course Description

REPORT ON CANDIDATES WORK IN THE CARIBBEAN ADVANCED PROFICIENCY EXAMINATION MAY/JUNE 2012 HISTORY

Essential Question: How might we use chronologies to learn about the past?

Science Studies Weekly 5th Grade

Guide to the Program in Comparative Culture Records, University of California, Irvine AS.014

Clerical Skills Level II

Economics Unit: Beatrice s Goat Teacher: David Suits

Episode 2 Lesson Plan: Steel the Great Conqueror

Boston MA Visitors Street Map By American Map

Bachelor of Arts in Gender, Sexuality, and Women's Studies

NATIONAL ASSESSMENT OF EDUCATIONAL PROGRESS ACHIEVEMENT LEVELS

GERMAN STUDIES (GRMN)

Content Teaching Methods: Social Studies. Dr. Melinda Butler

Missouri 4-H University of Missouri 4-H Center for Youth Development

Prentice Hall Outline Map 1914 With Answers

Let s Meet the Presidents

Pop. Culture Mid-term Study Guide

International Business BADM 455, Section 2 Spring 2008

Close Up. washington & Williamsburg High School Programs

Hist 1210, World History 1 Fall 2014

Courses below are sorted by the column Field of study for your better orientation. The list is subject to change.

Yosemite Lodge #99 Free and Accepted Masons 1810 M St, Merced CA 95340

Understanding Fair Trade

Summarize The Main Ideas In Nonfiction Text

Experience: Virtual Travel Digital Path

KOREAN 305: ADVANCED KOREAN I (Fall 2017)

PTK 90-DAY CRASH COURSE CALENDAR

Airplane Rescue: Social Studies. LEGO, the LEGO logo, and WEDO are trademarks of the LEGO Group The LEGO Group.

CHAPTER V IMPLEMENTATION OF A LEARNING CONTRACT AND THE MODIFICATIONS TO THE ACTIVITIES Instructional Space The atmosphere created by the interaction

Zambian Syllabus For Civic Education Grade 10

Guide to the Clarice Chase Dunn Papers,

Lincoln Film Study Guide Answer Key

Treasures Triumphs Practice Grade 4

First and Last Name School District School Name School City, State

OVERVIEW Getty Center Richard Meier Robert Irwin J. Paul Getty Museum Getty Research Institute Getty Conservation Institute Getty Foundation

RIVERS AND LAKES. MATERIA: GEOGRAFIA AUTORI Stefania Poggio Angela Renzi CONSULENZA: Cristina Fontana I.C. COMO-LORA-LIPOMO

Dear campus colleagues, Thank you for choosing to present the CME Bulletin Board in a Bag : Native American History Month in your area this November!

Students will analyze governmental institutions, political behavior, civic engagement, and their political and philosophical foundations.

Eye Level Education. Program Orientation

Transcription:

STRAND STANDARD OBJECTIVES (What it looks like in the classroom) The learner will # OF DAYS NEEDED FO R MASTERY DATES TAUGHT DATE ASSESSED ASSESSMENT TYPE (classroom, STAR, objective, subjective, project, etc.) RESOURCES (Materials, web sites, auto-visual, print) LEARNING ACTIVITIES Civics Civics SS 5.1.1 5.1.2 SS 5.3.1 SS 5.4.1 5.4.2 5.4.3 5.4.4 5.4.5 SS 5.1.1 5.1.2 SS 5.4.1 5.4.2 5.4.3 5.4.4 5.4.5 TLW identify and locate the thirteen original colonies. TLW have and understanding of colonial life. TLW identify and discuss the heroes from the Colonial times. TLW create a timeline of important events in the Revolutionary period. TLW identify people and events that affect the Revolutionary period. TLW become familiar with documents from the Revolutionary period. TLW identify the outcome of the Revolutionary War. 13 12 CPS test Or Objective classroom assessment CPS test Or Objective classroom assessment A Day in the Life Williamsburg tapes 8 stories Kids Discover Build Our Nation Unit 3 Tub Resources Build Our Nation Unit 4 Kid s Discover Tub Resources See attached Daily Plans See attached Day by Day plans Form developed by ESU #6 Page - 1 -

STRAND STANDARD OBJECTIVES (What it looks like in the classroom) The learner will # OF DAYS NEEDED FO R MASTERY DATES TAUGHT DATE ASSESSED ASSESSMENT TYPE (classroom, STAR, objective, subjective, project, etc.) RESOURCES (Materials, web sites, auto-visual, print) LEARNING ACTIVITIES Civics Civics Civics SS 5.1.1 5.1.2 SS 5.3.5 SS 5.1.1 5.1.2 SS 5.3.5 5.3.6 SS 5.4.1 5.4.3 SS 5.1.1 5.1.2 SS 5.3.5 5.3.6 TLW create a timeline of important events/battles in the Civil War. TLW identify people and events that affect the Civil War. TLW be aware of cultural challenges of people in the south during the Civil War era. TLW identify the outcome of the Civil War. TLW explain the historical perspective of the diverse cultural and ethnic groups TLW identify major events in the 20 th century and their influence on shaping America 12 Combined with 20 th century unit CPS test Or Objective classroom assessment Project Essay test Objective assessment Project Essay test Objective assessment Build Our Nation Unit Kid s Discover Tub Resources Build Our Nation Unit Kid s Discover Tub Resources Build Our Nation Unit Kid s Discover Tub Resources See attached Day by Day plans Discuss the from Civil War era to Civil rights era and different perspectives of the southern states and northern states at that time in history. See attached Day by Day plans Form developed by ESU #6 Page - 2 -

STRAND STANDARD OBJECTIVES (What it looks like in the classroom) The learner will # OF DAYS NEEDED FO R MASTERY DATES TAUGHT DATE ASSESSED ASSESSMENT TYPE (classroom, STAR, objective, subjective, project, etc.) RESOURCES (Materials, web sites, auto-visual, print) LEARNING ACTIVITIES Civics SS 5.1.1 5.1.2 TLW relate current events and their relationship to American. Economics SS 5.2.1 TLW describe the role of CPS test File Folder See attached Day by 5.2.2 producers and consumers Or Objective resources Day plans 5.2.3 in a market economy. classroom 5.2.6 TLW describe the assessment 5.2.10 function of money, 5.2.12 savings, and credit. TLW explain the impact SS 5.3.1 of human, capital, and 5.3.2 natural resources on the 5.3.4 economy. 5.3.6 TLW have an understanding of the geography of our country during the Civil War era and how it affected the economy. Economics SS 5.2.1 5.2.2 5.2.3 5.2.12 n h mb it o d C e TLW will explain Build Our Nation Covered during Civil industrialization and the Unit War Unit and Post growth of American with Kid s Discover Civil War unit immigration. Tub Resources SS 5.3.2 5.3.4 5.3.6 Form developed by ESU #6 Page - 3 -

STRAND STANDARD OBJECTIVES (What it looks like in the classroom) The learner will # OF DAYS NEEDED FO R MASTERY DATES TAUGHT DATE ASSESSED ASSESSMENT TYPE (classroom, STAR, objective, subjective, project, etc.) RESOURCES (Materials, web sites, auto-visual, print) LEARNING ACTIVITIES Civics SS 5.1.1 The learner will identify CPS test Build Our Nation See attached Day to 5.1.2 and describe Or Objective Unit 5 Day Plans responsibilities of the classroom Kids Discoverer SS 5.4.1 three branches of assessment United Streaming 5.4.2 government. STAR We the People 5.4.3 TLW define and 5.4.4 demonstrate correct 5.4.5 usage of political vocabulary. TLW become familiar and experience the Preamble, Bill of Rights, Articles and Amendments of the Constitution. Economics SS 5.2.1 TLW have an CPS test Nystrom Junior See attached Day to 5.2.2 understanding of the Or Objective Geographer Day Plans 5.2.3 geography and how if classroom Atlas, Globe, Desk 5.2.12 affects the economy of assessment and Raised Relief colonial life. STAR Maps SS 5.3.1 5.3.2 5.3.5 5.3.6 3 1 SS 5.4.4 5.4.5 Form developed by ESU #6 Page - 4 -

STRAND STANDARD OBJECTIVES (What it looks like in the classroom) The learner will # OF DAYS NEEDED FO R MASTERY DATES TAUGHT DATE ASSESSED ASSESSMENT TYPE (classroom, STAR, objective, subjective, project, etc.) RESOURCES (Materials, web sites, auto-visual, print) LEARNING ACTIVITIES SS 5.3.1 5.3.2 5.3.4 5.3.6 SS 5.4.2 5.4.4 5.4.5 SS 5.3.1 5.3.2 5.3.4 5.3.5 5.3.6 SS 5.4.1 5.4.2 5.4.3 5.4.4 5.4.5 TLW use maps and gloves CPS test Nystrom Junior See attached Day to to inform knowledge. Or Objective Geographer Day Plans TLW examine location, classroom Atlas, Globe, Desk place, region, enviroment, assessment and Raised Relief and movement. STAR Maps TLW identify and interpret primary and secondary sources. TLW Build Our Included in Post Review Life on the Westward Expansion Nation Unit Civil War to Plains, Pony Express, identifying reasons Kid s Discover Current Day unit Transcontinental behind American Tub Resources RR, California Gold expansion in the late Rush, Oregon Trail 1800s. Fifth grade Social Studies is a year-long class that is typically divided into two semesters. One fifth grade SS teacher teaches Explorers, Economy and Mapping. A different teacher teaches American from Colonization to Current Day. Students change teachers at semester to complete the full course. As the textbooks are not the primary source for fifth grade Social Studies, the Daily Lesson Planners are the most useful starting point for new teachers. The materials for each unit are stored in tubs or files in the fifth grade rooms. There are more resources than there is time in the curriculum schedule to use, therefore, the following plans are for teacher use only. They are a work in Form developed by ESU #6 Page - 5 -

progress and vary somewhat from year to year. For instance, during a Presidential election year, an election unit is implemented in which the 5 th grade students conduct a school election. This requires deviation from the master plan. Social Studies field trips: Wessels Farm and The State Historical Society WWII exhibit Form developed by ESU #6 Page - 6 -

Different Worlds Meet Explorers Day 1: Read p 35 46 Do workbook p 13,14,16 Day 2: Read 40-63 Do p 20-22 Day 3: Read 34-67 Do p 23-24 Day 4: Read 73-85 Do p 26-30 Day 5: Read 72-87 Do p 31-32 Day 6: Read 89-105 Do 34 and 36 Day 7: Go over yesterday s work Read p 106-115 Assign p 38-40 Day 8: Go over work from Day 7 Read p 111-119 Assign p 43-44 Day 9: Go over work from Day 8 Read p 46-50 Day 10: Go over work from Day 9 Read pg 134-147 Assign pg 50-54 Day 11: Go over work from Day 10 Read pg 142-147 Assign p 56 Day 12: Go over work from Day 11 read pages 120-153 Do pages 57-68 Day 13 Review teacher generated Day 14: Colonization Quiz open book Day 15: CRA 5.4.1 Day 16: Celebrate Go over tests Colonization Unit Plans Day 1: Review explorers looking for China. Mention Marco Polo and Kubla Kan and have students turn to page 91 to look at map of Portuguese trade routes. (talk about slaves brought back on way home) Talk about Columbus finding short cut to India. Use cut up map to show world without Americas and wrap it up to show how it would have worked if he wouldn t have run into Americas. Have students turn to page 93 to look at his route. Ask if they know now why we call Native Americans Indians. Turn to page 142 and look at the maps and talk about the French and Dutch finding a northwest passage. Use hand signals to remember Spain explored and settled in the south New Spain French in the north and then talk about the English settlements on page 128. Roanoke and Jamestown. Day 2: Teach story about the 13 colonies. Start reading Chapter 6 highlighted parts about New England colonies Day 3: Review story and teach chapter 7 highlighted parts about Middle Colonies Day 4: Review story and teach chapter 8 highlighted parts about southern colonies Day 5: Make envelope study guides for colonies Days 6-13: Start Williamsburg videos - Review time Day 14: Test Kids Discover magazine Form developed by ESU #6 Page - 7 -

Revolutionary War Unit Day 1: Give Citizenship Test - Grade and keep for end of the year post-test Day 2: Chapter 9 234-239 Day 3: P 242-245 skim give worksheet and then watch Seeds of Liverty, Causes of the American Revolution on Digital Streaming (saved in videos folder) give chapter review sheet 97/98 Day 4: Skim 249 255 262-265 give worksheet used overheads to review 1-1/102 Day 5: Read 270-273 Do worksheet 106 Day 6: United Streaming American Revolution The War of Independence Day7: United Streaming American Revolution Day 8: Study of the Declaration of Independence Day 9: Skim 278-297 using Overheads Day 10: p 294-297 Unit Review Day 11 CPS review Day 12 Test 5 th Grade Government Unit Day 1: Give citizenship test - Hand out packets for Executive branch Day 2: Highlight info on Executive Branch Day 3: Highlight info on Executive Branch Day 4: Watch Almost painless executive branch on video streaming Day 5: Hand out and highlight info on legislative branch Day 6: highlight info on legislative branch Day 7: Watch Almost Painless Legislative branch Day 8: Watch Almost Painless Judicial branch and go over handout Day 9: Give the branches review sheet allowing kids to glue on the pieces (assign test for Day 10: Play a game with review sheets (4 corners with 3 corners) Day 11: Watch a video Liberty Kids if nothing else Day 12: test 3 days later Form developed by ESU #6 Page - 8 -

Civil War Unit Plans Day 1-2: Age of Jefferson Chapter 13 War of 1812 Day 3-4 Chapter 14 Jackson Industrial Revolution North and South Day 5 Make mice in fall and May baskets in spring for mass production example. Day 6 Tex-Mex war Chapter 15 Day 7-9 Pass out study guide sheets and fill in as you finish the unit. Play the sections of American Civil War, The causes of war saved in videos from United Streaming, filling in the answers that go with each section. Turn to page 432-433 and read Marching to Battle and then fill in the info from that section. Play the Gettysburg address saved in videos Read through page 7 of Kids Discover including the battles. Read rebuilding section of the book 455-459 and finish the study guide with this. Give students a date for the test and emphasize the need to study the guide. Day 10-11 Complete the scavenger hunt and review for test Day 12 CPS review Day 13 TEST and let them finish reading Kids Discover Civil War to Present Day Day 1: Review timeline from 1776 to 1920 1776 Independence 1800 Industrial Revolution Native American Removal Cotton gin slavery 1834 (49) 50s Oregon Trail Morman Trail Gold Rush 1850 Conflicts as states add on slave states or free states? 1860 President Lincoln elected 1861 Civil War 1865 Civil War ended 1867 NE a state 1869 Transcontinental Railroad Plains becoming settled 1870 Industrial Society Immigration Ellis Island 1914 WWI 1917 Lusitania sank U.S. joins the war Form developed by ESU #6 Page - 9 -

1918 War ends Day 2 1920s Roaring 20s Kids Discover 1930s Depression Wessels stories 1940 WWII began in Europe Day 3 1941 December 7 Pearl Harbor Digital Learning in Focus 1940-1949 1 st Sports and Games (Rose Bowl with NE) 2 nd WWII comes to America (talk about women in factories, war bonds, war ration cards how it affected Nebraskans 3 rd WWII Effects in America Wessels stories if time especially about Japenese Americans Day 4 Kids Discover WWII Day 5 DAD and MOM interview Day 6 Tour of Historical Society in Lincoln Day 7 Nazi concentration camps and Atomic Bomb Digital Learning Mapping Unit Day 1: Intro to Nystrom Junior Geographer Assign 1a and 1b Day 2: Maps and Globes Assign 1c and 1d Go over together in class Day 3: Decoding Maps and Globes Assign 2c and 2d Go over together in class Day 4: Decoding Maps and Gloves Assign p 3a and 3b Day 5: Decoding Maps and Gloves Assign 3 c and 3d Grade these Day 6: Continents and Oceans Assign 4a and 4b Go over together in class Day 7: North and South Assign 5a and 5b Go over together in class Day 8: East, West and Intermediate Directions Assign 6a and 6b Go over together in class Day 9: Map Scale Assign 7a and 7b Go over together in class Day 10: North South East and West Review Do Mapping Review #1 teacher generated Go over together in class Day 11: Mapping Quiz #1 Teacher generated Day 12: Political Maps Assign 8a and 8b Go over together in class Day 13: Physical Maps Assign p 9a and 9b Go over together in class Day 14: Northern and Southern Hemisphere Assign Nustrom p 13a and 13b Go over together in class Day 15 Eastern and Western Hemisphere Assign p 14a and 14b Go over together in class Day 16 Latitude Assign 15a, 15b, 15c, 15d Go over together in class Day 17 Longitude Assign Nystrom 16a, 16b, 16c, 16d Go over together in class Form developed by ESU #6 Page - 10 -

Day 18: Road Maps Assign Nystrom 18a, 18b Go over together in class Day 19: Thematic Maps Oral lesson using Rainfall, Temperature, climate and timezone maps Day 20 Mapping Review #2 Teacher generated Go over review and study Day 21 Mapping Quiz #2 teacher generated Day 22 Go over Mapping Quiz Use Eggspert to answer mapping questions Economy Day 1: Kings Ransom Day 2: Finding Houses comparing making choices 7,8 Day 3and 4: Kids Discover Day 5: Dandy Dollars Consumer Producer 1,2,5,6 Day 6 and 7: Lemonade Stand markets Free enterprise 3,6,5,9,10,12,13,24 Day 8 Logos/ Advertisement Day 9, 10, 11: How much people earn Budgets checks Day 12: Businesses What people earn Jobs 14, 22, 23, 26, 27, 28 Day 13: Checks/cash/credit cards 16,17,18 Day 14: Banks Loans Interest Govt s role Day 15: The Price is Right Day 16: CRA Review Day 16: CRA Day 17 and 18: The Game of LIFE SEE GLOSSARY OF BUILD OUR NATION FOR VOCABULARY LIST Form developed by ESU #6 Page - 11 -

June 2009 - May 2010 June 2009 December 2009 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 July 2009 January 2010 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 August 2009 February 2010 5 TH GRADE SOCIAL STUDIES TAUGHT M, T, TH, F 1 2 COLONIZATION 15 TO 20 DAYS 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 35 MINUTE CLASSES Different Worlds Meet Explorers 15 TO 20 DAYS 1 2 3 4 5 6 REVOLUTIONARY WAR 7 8 9 10 11 12 13 13 TO 15 DAYS 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 September 2009 March 2010 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 MAPPING 22 TO 24 DAYS 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 GOVERNMENT 12-15 DAYS 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Form developed by ESU #6 Page - 12 -

October 2009 April 2010 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 POST CIVIL WAR TO CURRENT 4 5 6 7 8 9 10 CIVIL WAR 12-15 DAYS 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 November 2009 May 2010 1 2 3 4 5 6 7 ECONOMY 18 TO 24 DAYS 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Form developed by ESU #6 Page - 13 -