SpeakUp! Event Registration

Company
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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)
Family Issues and Young Adult Life
- Why plus size individuals viewed as unhygienic
- Unrealistic body image
- Preference of body type
- Oversexualization
- Projection
- High expectations
- Negative thoughts/Insecurity
- Eating disorders
- Does SM impact the way you view your BI?
- What does BI mean to you?
- BI influenced by personal perception by society standards?
- What does healthy self-esteem look like?
- How clothes affected by media play a role in self esteem?
- Do you think BI concerns affect both genders equally?
Mental Health
- Heavy workload; additional responsibilities
- Older generations misunderstanding MH
- Stigmatizing MH
- Being afraid/ashamed of seeking help
- Stages and symptoms of depression
- Lack of self-awareness/self-esteem/MH resources
- Cost of MH resources (therapy)
- Reliance of medication; abuse/addiction
- Suicide awareness
- School effect; bullying/stress/burnout
- Social media
- Ways to cope
- Finding time for self-care
- How can we support our MH through relationships?
Sexual Education
- Offensively using slurs
- Stereotypes (racial and gender)
- Generation of hispanics
- Double standards of men and women
- Idea of being "White-washed"
- Internalized racism, sexism, and homophobia
- Dark skin vs. Light skin/Skin bleaching
- How colorism affected you?
- Men getting paid more
- Toxic masculinity vs. Extreme feminist
- Over sexualism
- Men vs. women in sports
- Gentrification
- Racial pay gaps/Racial profiling
Teenage Smoking
- Toxic relationships/Unhealthy competition
- Emotional/physical abuse
- No contact/communication
- Being fake/dramatic/insecure
- Peer pressure/Expectations
- Parasocial
- Mutual respect
- Trauma bonding
- Idealization
- Pressure for sexualization
- Power imbalance
- Friendships
- Being left out/no time for you
- Love bombing
- Time consuming
- How to express yourself
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)

Family Issues and Young Adult Life

Mental Health

Sexual Education

Teenage Smoking

Family Members Attending

Special thanks to our Corporate Partners