Teacher Consent Information:
Participation in 5 Radical Minutes Program Evaluation

Purpose and Benefits

Your school is implementing 5 Radical Minutes, a program designed for students in K-12 schools to build deeper connections with one another. The developers of 5 Radical Minutes are hoping to better understand how the program is working for your school and are partnering with Dr. Susan Ruby in Eastern Washington University’s Psychology Department to analyze existing data and to survey teachers who currently use the program.  Dr. Ruby will provide a report to the developers of 5 Radical Minutes that summarizes the data, and the program developers will use the information to implement improvements in the program.


The following survey includes 15 questions and should take approximately 5 minutes to complete.  The survey asks about your use of the 5 Radical Minutes Program and how you feel the program is working.  Participation in this study is voluntary. You do not have to answer any questions you do not feel comfortable answering. If at any time and for any reason you would prefer to not participate in this study, you can withdraw from the study without being penalized in any way.

Risk, Stress, Discomfort and Potential Benefits

Any risks associated with answering the following questions do not exceed those encountered in daily life. The questions are seeking your perception of the program implementation benefits and challenges in your school/district. You are not likely to have any direct immediate benefit from participating in this research study. This study is designed to learn more about the 5 Radical Minutes program and may help with future implementation of 5 Radical Minutes. Findings from the study may also help schools understand the benefit of participating in the program.

Other Information

Your completion of this survey is voluntary and your responses are confidential.  All data collected will be kept in a secure digital server.If you do complete the survey, your name and your school’s name will remain confidential.  Names will be changed to ID numbers for research purposes. If you have any questions about the study, please contact Dr. Susan Ruby, EWU School Psychology Program Professor by phone at (509) 359-6050 or by email at sruby@ewu.edu.If you have questions or concerns about your rights as a participant in this study or any complaints you wish to make, please contact Ruth Galm, Human Protections Administrator, 509-359-7971 or rgalm@ewu.edu. This study is intended for individuals who are 18 years of age or older.

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