SpeakUp! Event Registration

Please complete the form below to register for an upcoming SpeakUp! event:
Participant Info
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Speakup Staff
You can select from contacts that have been previously assigned to a Facilitator, Staff, or Volunteer Group in CiviCRM
Choose Prior
Select the SpeakUp! Event you're registering for:*
Name*
.
First Last
Address*
Street Address City State Zip Code
Email*
Phone*
Phone number will be used if additional support is needed during or after the event.
Which gender pronouns do you identify with?*
Are you on the Student Leadership Team for this event?*
Participant Type*
School Staff Type*
Which school are you associated with?*
Student's grade*
Student's High School Graduation Year*
Grade to Graduation Year Chart
6th: 2031
7th: 2030
8th: 2029
9th: 2028
10th: 2027
11th: 2026
12th: 2025
Breakout Session
You will be participating in ONE Breakout Session. Please Rank your top Breakout choices in order of preference: (1-3)
Topics (click here to view topic talking points)
Issues with Teachers and Friends
- Toxic relationships
- How to end/identify relationships
- How to build relationships
- Family relationships (parent&sibling)
- Romantic relationships
- Platonic relationships
- Ghosting
- Power dynamics
- Relationship w/ teachers and trusted adults
- EA community relationships
- Student to student
- How to connect
- Social media & its effects
- Boundaries
- Relationship w/ yourself
Need for Adult Validation
- Sexual identity
- Racial/ethnic identity
- How does identity contribute to your community?
- Religious vs culture at EA
- Choices regarding joining affinity groups
- Family culture
- Intersectional identities
- Multi-racial or cultural identities
- How can schools promote & include diverse identities?
Fears of the Future
- How to grow your community
- Found family
- Does your community define you?
- How to strengthen community?
- Do you feel connection to community?
- Meeting new people
- How to make a difference in your community
- How to get out of a toxic community
- How to diversify your community
- Being open-minded
- Inclusion of others
- People who aren't like you
Suicide/Mental Health
- Stigmas at school
- Academic pressure
- Grades impact MH
- Awareness + education
- Finding trusted people
- How to help/identify a friend struggling?
- How to promote conversation about MH
- Finding balance
- Don't battle up emotions
- How to find "your people"
- Maintaining good MH
- Introvert/extrovert
Topics: 1st Choice*
Topics: 2nd Choice*
Topics: 3rd Choice*
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Topic/Room Selection
Note: Please be sure you have selected 3 different Topics.
*We will do our best to give you your first choice topic, but it is not a guarantee.*
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Contact Preference
- Click here to opt-out of Speakup! emails which include valuable resources, Parenting Adult Coffee Invitations, School Adult Discussion Invitations, Youth Mental Health First Aid Training Opportunities and much more.
Will other family members be attending this SpeakUp! event?
Family Members Attending
NOTE:THIS DOES NOT REGISTER THAT FAMILY MEMBER. All Participants must register separately. Listing family members below ensures you will not be in the same breakout with those listed.
Attending Family*
First name Middle initial Last name This person is my
e.g. Parent's name is John Smith and email is [email protected], and student's name is also John Smith with an email address of [email protected]
- My name and email address are the same as my child or parent.
e.g. Parent's name is John Smith and email is [email protected], and student's name is also John Smith with an email address of [email protected]
Comments
This field is for validation purposes and should be left unchanged.

First name	Middle initial	Last name	This person is my

Participant Info

Breakout Session

Topics (click here to view topic talking points)

Issues with Teachers and Friends

Need for Adult Validation

Fears of the Future

Suicide/Mental Health

Family Members Attending

Special thanks to our Corporate Partners

SpeakUp!