EmpowerED Early Bird Registration Form

Campaign ID

Event Center

Center Event ID

Modality

Number Registered

Max Capacity

Catering?

Yes

Event

Start Date

End Date

Start Time

End Time

Location

Payment

Registration payment can be made at the time of registration via credit card. To register a group from a school or district, please email scsmh-main@uiowa.edu. We also do not accept cash for registrations.

Cancellation Policy

Purchases made for in-person events are nonrefundable, but they are transferable until three weeks prior to the start date of the event.

Transfer Policy

We are happy to assist with conference registration transfers when necessary. Please email scsmh-main@uiowa.edu to complete a transfer. Conference registration transfer is for registrants from the same school, district, institution, or organization. The deadline to complete transfers is Friday, September 5.

Consent to Use Video or Photographic Images and Share Information

*By registering for this event, you agree to be photographed or filmed for promotional purposes.

First Name

Last Name

Work Email

Mobile Phone Number

Employer or Affiliation Name

Street Address

City

State

Zip Code

Country

University/College/Institution Name (Start typing the name to see results)

University Student Role Salesforce ID

Role #6

Student

My University or College is not listed

My University/College/Institution is not listed

University/College/Institution Information

University/College/Institution Name

New University/College Street Address

New University/College City

New University/College State

New University/College Zip Code

New University/College Country

Which degree program are you currently pursuing?

Your anticipated graduation date (e.g., Spring 2026)

Which degree program are you currently pursuing?

Your anticipated graduation date (e.g., Spring 2026)

Additional Information

Are you an alum of the University of Iowa?

YesNo

Is this your first time attending a Scanlan Center for School Mental Health professional learning event (i.e. workshop, webinar, training)?

YesNo

Are you a parent to a PreK-12 student?

YesNo

Other Details

Please list any dietary restrictions (N/A if not applicable)

Do you require accommodations throughout the conference (i.e., sign language interpreter)?

YesNo

Poster Session and Networking Reception

Do you plan to attend the "Research Bites and Connection Night" on the early evening of Tuesday, September 30th at the Iowa Events Center?

YesNo

Early Bird K-12 Conference Fee

First Name

Last Name

Card Number

Expiration Month

Expiration Year

CVV

Email Address

Phone Number

Street

City

Postal Code

State

Country

Pre K-12 and Other Regular Conference Fee

First Name

Last Name

Card Number

Expiration Month

Expiration Year

CVV

Email Address

Phone Number

Street

City

Postal Code

State

Country

Early Bird Higher Ed Conference Fee

Early Bird Campus Well-Being (Higher Ed) Conference Fee

First Name

Last Name

Card Number

Expiration Month

Expiration Year

CVV

Email Address

Phone Number

Street

City

Postal Code

State

Country

Grad Student Conference Fees

Graduate Student Conference Fee

First Name

Last Name

Card Number

Expiration Month

Expiration Year

CVV

Email Address

Phone Number

Street

City

Postal Code

State

Country

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