R proved For Release 2000/08/09 : CIA-RDP96-00792R000600160002-3 EN DEFENSE INTELLIGENCE AGENCY i WASHINGTON. D.C. 20301-6111 STATEMENT OF CONSENT DIA SUN STREAK PROJECT PARTICIPANT Date: 1. - (S/SK) I, voluntarily accept: assignment to the DIA SUN STREAK PROJECT (DSSP) and fully understand that: a. (S/SK) The DSSP is an experimental program that applies psychoenergetics research.to intelligence activities. Specifically, the mission of the DSSP is to collect intelligence information through the use of psychoenergetic technology. Psychoenergetics is the process by which an individual perceives, communicates with, and/or perturbs characteristics of a designated target, person, or event remote in space and/or time from that individual by mental means. Development and use of DSS§P Operational intelligence collection personnel will be accomplished in accordance with established procedures. The Deputy Secretary of Defense has granted approval for the conduct of DSSP activities in accordance with Procedure 13, DoD 5240.1-R. b. (C/NOFORN) Assignments in DSSP are governed by the type and degree of expertise required for the position, and are made according to individual capability and experience, regardless of rank or previous position. 1 understand that I may at any time ask questions of the Commander, Prototype Operational Group (POG), DSSP or other appropriate project personnel relating to areas unclear to me. Additionally, I: understand that my participation in DSSP is voluntary and that at my request I may at any time be reassigned without fear of adverse personnel action. The nature of my involvement in DSSP‘ along with associated records will be protected under project security measures. c. (S) Upon my assignment to the DSSP, the primary consideration will be the Project's mission and operational requirements. JI understand that this may consequently delay normal career development patterns such as branch schooling and assignment Opportunities, and that these disruptions may prejudice future promotion and assignment potential; however, I have been assured that every effort will be made to preclude the adverse effects mentioned above on my career. d. (S/SK) I understand that there is no demonstrated risk of permanent or temporary injury (including physical, psychological CLASSIFID BY Mulitiple sources SPECIAL ACCESS REQUIRED DECLASSIFY ON OADR HANDLE VIA SKEET CHANNELS ONLY Approved For Release 2000/08/09, 22R000600160002-3
* * Approved For Release 2000/08/0 -R P96-00792R000600160002-3 “7 and/or damage to participants' reputation) to project personnel beyond risks to which they would ordinarily be exposed in their daily lives. However, I understand further that potential for injury during DSSP-related activities cannot be conclusively ruled out. . f. (S/SK) I may temporarily choose not to particpate in the project at specific times, or permanently discontinue participation without prejudicial effect. Termination or temporary declination will be affected by notifying the Commander, POG, DSSP or his designated representative. 2. (S/SK) As a participant in DSSP, and IAW DoD 5240.1-R, I consent to video and/or audio recording, monitoring and transcribing of all training and operational interviews in which I am in any way involved as part of the DSSP mission. I understand that these recordings are subject to being monitored and/or transcribed by third parties not otherwise involved in operations or training. 3. (C/NOFORN) I hereby acknowledge receiving separate counseling concerning my assignment to DSSP. Fundamental training and operational procedures and their purposes, as well as any attendant discomforts, risks, and benefits have been explained to me. Signature (Witness) Signature. (Participant) Name, Rank/Grade Name, Rank/Grade Social Security Number . Social Security Number DATA REQUIRED BY THE PRIVACY ACT OF 1974 (5 U.S.C. 552a) 1. Authority: Title 10, U.S.C. Section 8012; Title 44, U.S.C., Section 3101 and EO 9397. 2. Principal Purpose: To maintain a record of those individuals who have executed statements of informed consent as participants in DSSP. ha 3. Routine Uses: The Social Security Number is to be used to identify the individual, and the information is to be retained strictly within the program. 4. Mandatory or Voluntary Disclosure: Information is disclosed on a voluntary basis, but withholding information will render it impossible to grant an individual access to or participation in the program. Approved For Release 2000/08/09 : PN Pe poo 160002-3