SpeakUp! Event Registration

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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.
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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: 2032
7th: 2031
8th: 2030
9th: 2029
10th: 2028
11th: 2027
12th: 2026
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)
Gun Violence
- Legality of guns
- Stricter protocols/underage gun buyers
- Accessibility/how easy it is to buy an illegal gun
- Gang violence/street violence
- Not talked about until it happens
- Gun safety/how to store your gun at home
- Hypocrisy/double standards
- Selective empathy
- School shootings/mass shootings
- Conflicting country affairs
- Emotional loss of loved ones/neighbors/grief
- Going to certain areas at different times in day
- Media
- Grooming with guns
Money/Social Status
- Participation in school/sports/uniform
- Comparison/expectations
- Trends/cars
- Balancing a job/managing money
- Accessibility (requirements)
- How does money affect students' social lives?
- Discrimination- both ends
- Stereotyping
- Nepotism/paying way up ranks/working hard
- Poverty in neighborhoods
- Talking about wealth
- Disinclusion
- Social status/wealth you are born into
Differences of Beliefs
- Kid vs. parent perspective/generational division
- How are teens meant to find their political beliefs
- Agreeing to disagree/respecting not silencing
- Open to growth/acceptance
- How beliefs apply/politics are personal
- Use your voice/discourse prepares for adulthood
- Misinformation/where do you get your news
- Parents letting go of fear, trust in their parenting
- Courageous convos w/those w/different opinions
- Religion
- Affects of policies (SEPTA, FAFSA, ICE)
- Immediate hostility when politics are brought up
- Sexuality
- Changes in politics/government
- Peaceful protests/boycott/media
- Discrimination/profiling/slurs/derogatory terms
- We are all humans/validating experiences
Relationships
- Comfortability talking with parents/guardians/etc.
- Sex ed- lack of knowledge; gender differences
- Protection
- Platonic/romantic
- Mental health
- Peer pressure
- Social media vs. reality/use of AI
- Stigma
- Religion/morality/private school
- Exposure (nudes, private convos)
- Hook-up culture
- Addiction
- Body standards
- Family and friends
- Selfishness
- Sexual orientation/sex and gender
- Rape/assault
- Consent
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]

First name	Middle initial	Last name	This person is my

Participant Info

Breakout Session

Topics (click here to view topic talking points)

Gun Violence

Money/Social Status

Differences of Beliefs

Relationships

Family Members Attending

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