SpeakUp! Event Registration

LinkedIn
This field is for validation purposes and should be left unchanged.
Please complete the form below to register for an upcoming SpeakUp! event:
Participant Info
This field is hidden when viewing the form
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.
This field is hidden when viewing the form
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)
Self-Image & Identity
- Why do people compare (Self-Comparison)
- Insecurites
- Finding your people
- Trying to fit in
- Envy
- Bullying
- Positive affirmations
- Internal & External Judgement
- Cultrual tradtions & Personal intrest / hobbies
- Should you ask for help?
Parental Pressure/Expectations
- Parental figures not listening / rigid
- What if your parents are the problem
- Parents stressing about success
- Future talk too early (college)
- Talking to people
- Lack of trust / trust issues
- Journaling / alone time (coping)
- External examples (tv shows)
Mental Health & Suicide
- How can you tell? Signs or Symptoms?
- What is it? Is there a cause?
- Difference between being upset or suicide?
- Familial / close to home suicide
- Jokes about it can be scary
- Sports as a way to have positive mental health
- Talking to a friend
- Realizing / being grateful for everything you have
- Talking to experts
- Doing research about it
Conflict Resolution
- What starts conflict?
  
  How do we resolve conflict?
  
  It's not you, it's me
  
  How to address conflict?
  
  Describe a time you experienced conflict
  
  Do you stay calm during conflict? How?
  
  Being open to the other person(s) opinion
  
  Think / Talk about it
  
  Reading books
  
  Standing up for yourself
  
  Listening to music
  
  Going for a walk / roll
Topics: 1st Choice*
Topics: 2nd Choice*
Topics: 3rd Choice*
This field is hidden when viewing the form
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.*
This field is hidden when viewing the form
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)

Self-Image & Identity

Parental Pressure/Expectations

Mental Health & Suicide

Conflict Resolution

Family Members Attending

Special thanks to our Corporate Partners