Presidential Initiative Engagement Form

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Host information

First name:

Last name:

Email:

Phone:

Institutional/organizational affiliation:

Position title:

Institution/organization address:

Type of institution/organization:

Specify institution/organization:

Event information

Please note: Events must take place at a high school or on a community college campus in the

U.S. If preferred, the event may be held at a U.S. four-year college or university, however the

majority intended audience needs to be high school and/or community college students. (Note:

Applications that propose to offer the event at a setting other than a high school, community

college, or four-year college or university campus setting (e.g., at a public library or other venue)

will not be funded.)

Will the event be held at the same institution as above?

YesNo

Name of institution (high school or community college) where event will be held:

School address:

Name of school partner (e.g., teacher) if not the same as the host:

Planned date of event:

Planned time of event:

Target student audience:

Please include 1-2 sentences about the intended student audience (e.g., all students at a school serving historically underserved communities with an interest in psychology will be invited; students in an AP Psychology course at a suburban school; community college students enrolled in a course on psychology research methods; Psi Beta event at a rural school.)

How many student attendees do you expect?

Psychology professional speakers

Please note that a minimum of two (2) speakers is required, but you may include up to five (5)

speakers in total. At least one (1) speaker must hold a doctoral degree in psychology. All

speakers should be able to be in-person at the event. In the rare occasion that a preferred

speaker is only available virtually, that speaker may participate by videoconference, as long as

other speakers and the audience are in person and the host is able to provide the technology

needed for a speaker to virtually interact with the audience.

APA will not be conducting background checks on these speakers. If background checks are required by the school, that is the responsibility of the host and/or school.

Speaker #1

Name:

Degree

Email:

Position title:

Institutional/organizational affiliation:

Stage of training/career:

Area of study in psychology:

Specify educational field:

Speaker #2

Name:

Degree

Email:

Position title:

Institutional/organizational affiliation:

Stage of training/career:

Area of study in psychology:

Specify educational field:

Add additional speaker (optional):

Yes

Speaker #3

Name:

Degree

Email:

Position title:

Institutional/organizational affiliation:

Stage of training/career:

Area of study in psychology:

Specify educational field:

Add additional speaker (optional):

Yes

Speaker #4

Name:

Degree

Email:

Position title:

Institutional/organizational affiliation:

Stage of training/career:

Area of study in psychology:

Specify educational field:

Add additional speaker (optional):

Yes

Speaker #5

Name:

Degree

Email:

Position title:

Institutional/organizational affiliation:

Stage of training/career:

Area of study in psychology:

Specify educational field:

Host responsibilities

I understand that as host, I will:

Follow all local legal and procedural requirements, including obtaining any necessary parental or guardian consent.
Clarify that the speakers are sharing their own career stories and advice and not speaking as representatives of APA.
In the case of minors, ensure that all speakers are appropriately vetted, that there is adequate adult supervision throughout the event, and that speakers avoid sharing content that may be inappropriate content for children under 18.
Follow the guidance provided in the event playbook including sharing the provided QR Code at end of the event to all event participants and psychology professional speakers and encourage them to provide feedback via the linked survey.
Complete the post-event survey on the QR code myself as the host.
Share resources with the student participants (and teachers, if needed).

I understand and agree:

Yes

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