SpeakUp! Event Registration

Company
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)
Habits
- Addictive habits
- How do you cope with habits?
- How did you developed your habits?
- How to manage/improve negative habits?
- How can you get rid of bad habits?
- Who influences my habits?
- How can I talk about my habits?
- Having/dealing with short tempers
- Being mean to other people/ Getting mad too fast
- Getting up on time for school
- Not speaking up for yourself until too late
- Vaping
- Picking skin/ biting nails/ shaking leg/
- Grabbing necklace/ walking around
Family Problems

Working parents

Abusive (verbal, emotional, physical) family members

Separation/divorce

Family not getting along

Unfair treatment

Aggressive family members

Siblings

Unemployed parents

Cursing a lot / verbal fights

Stealing from family

Displacement from home/Parents putting you out

Being removed by CPS

Toxic family members

Trust issues

Family causing drama/problems

Family not the same as when we growing up
Mental Health/Depression
- How do I know I have depression
- How to know if someone else has depression?
- Is it ok for me to feel like this?
- What is mental health?
- How should I cope with depression?
- What makes people depressed?
- Why can people being mean trigger stress?
- Depression can make you feel lazy and tired
- Depression can lead to self-harm/ suicidal thoughts
- Depression can lead you to being alone/ Isolating
- How do you get rid of depression?
- Being misunderstood/ self-image
- Fake friends
- How bad does your mental health affect your life?
Talking to Parents/Adults
- Difficulty talking to parents/adults because of attitudes
- Talking to parents creates stress
- Feeling stressed due to misunderstanding
- Communication is difficult with parents/adults
- Why do adults/parents talk and not listen?
- Why are parents so judgmental?
- It is scary/difficult to talk about feelings
- Parents/adults do not believe that kids go through things too
- Conversations being seen or taken as disrespect
- Only talking to parents when you have problems
- Parents getting violent/upset
- Parents always asking for money
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)

Habits

Family Problems

Mental Health/Depression

Talking to Parents/Adults

Family Members Attending

Special thanks to our Corporate Partners