SpeakUp! Event Registration

Please complete the form below to register for an upcoming SpeakUp! event:
Participant Info
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: 2029
7th: 2028
8th: 2027
9th: 2026
10th: 2025
11th: 2024
12th: 2023
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)
Mental Health
- Relationship problems
- How to ask for help
- Isolation
- Family issues
- Depression
- Noticing signs of MH
- What does self-care look like?
- MH is not always visible
- Going through a breakup
- Self-harm
- Dark/intrusive thoughts
- Depression
- Ways to cope
- What resources to cope w/ MH
Family Issues
- Communication
- Co-parenting
- Parent losing a job
- Growing up in a single parent household
- Trust
- Boundaries
- Money problems
- Divorced parents
- Losing a family/relative
- Getting called names by your parents
- Too many responsibilities
- Family trauma
- Feeling left out
- Not feeling taken care of
Homophobia
- Dressing the way you want
- How to educate others
- Being bullied
- Pronouns/name change
- Gender correction
- People not expecting you to be bi-sexual
- Labeling people without asking first
- Sound of their voice
- Purposely misgendering
- Sexuality
- How to educate others
Race & Racism
- Being comfortable in your own skin
- Having mostly white teachers
- Mixed kids
- Being called “too black”
- Being treated differently because of your skin
- Colorism
- Racial slurs
- Too light for the black people but too dark for the white people
- Cultural appropriation
- Difference between racism and prejudice
- Bullying
Topics: 1st Choice*
Topics: 2nd Choice*
Topics: 3rd Choice*
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.*
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
- 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]
Email
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)

Mental Health

Family Issues

Homophobia

Race & Racism

Family Members Attending

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