STATEMENT OF CONSENT
DIA SUN STREAK PROJECT PARTICIPANT
SG1J
Date:
23 JUNE 19&6
1.
(S/NOFORN/WNINTEL)
I
accept
assignment
to
the
understand
that:
voluntarily
and
fully
a.
(S/NOFORN/WNINTEL)
The
DIA
and
DoD
General
Counsels
have
determined
that
the
DSSP
constitutes
experimentation
on
human
subjects.
As
required
by
Procedure
of
DoD
Directive
5240. 1-R,
approval
for
project
activities
has
been
granted
by
the
Deputy
Secretary of Defense.
b.
(S/NOFORN/WNINTEL)
The aim of
the DSSP
is
to develop highly
skilled
personnel
who
are
capable
of
conducting
professional
level
intelligence/counterintelligence
operations
through
the
use
of
psychoenergetics
methodology.
Development
of
DSSP
will
be
accomplished with special training based on mission requirements.
c.
(C/NOFORN)
Assignments
in
DSSP
are
governed
by
the
sensitivity
and
degree
of
expertise
required
for
the
position.
I
will
be assigned
in accordance with my capabilities
and
experience,
regardless
of
my
rank
or
previous
position.
Due
to
the
nature
of
training
involved,
the
duration
of
my participation
is
indefinite.
Records
of
my
involvement
will
be
available
to
project
personnel,
but otherwise protected under project security measures.
d.
(C/NOFORN)
The
primary
consideration
in
any
career
development
or
assignment
action
will
be
DSSP
mission
and
operational
requirements.
I
understand
that
exemption,
interruption,
or
delay
in
normal
career
development
patterns--such
as
branch
schooling
and
assignment
oppor tunities--may
prejudice
future
promotion
and
assignment
potential.
I
have
been
assured,
however,
that
every
effort
will
be
made
to
preclude
the
adverse
effects
listed above
on my career.
2.
(U)
PSYCHOENERGETICS
(PE)
include
various
processes
by
which
individuals
psychically
interact
with
objects,
locations,
and
organisms
.
a.
(U)
I
understand
that
while
there
is
no
demonstrated
risk
of permanent
or
temporary
injury
(including
physical,
psychological
and/or
damage
to
participants'
reputation)
to
project
personnel
beyond
risks
to
which
they
would
ordinarily
be
exposed
in
their
daily
lives,
the potential
for
injury during
some
training cannot
be
conclusively ruled
out.
NOT RELEASABLE 10 FOREIGN HmQNAI&
Approved For Release 2OO0fQlimaoQm-Rtm96-OO789ROO26OO1 60022-3
Approved For Releas
BBP96-00789R0026001 60022-3
b.
(S/NOFORN/WNINTEL)
I
may
temporarily
choose
not
to
participate
in
the
project
at
specific
times,
or
permanently
discontinue
participation
without
prejudicial
effect.
Termination
will
be
affected
by
notifying
the
DSSP Manager
or
in
his
absence,
his designated acting DSSP Manager.
3.
(S/NOFORN/WNINTEL)
As
a
participant
in
DSSP,
and
IAW
DoD
Directive
5240. 1-R,
I
consent
to
tape
recording,
monitoring
and
transcribing
of
all
training
and
operational
interviews
in which
I
am
involved
as
an
integral
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.
I
waive
any
claim
or
right
of
ownership
to
all
tape
recordings
and
transcripts
made
in
conjunction
with
DSSP,
with
the
understanding
that
these
tape
recordings
and
transcripts
are
property
of
the United States Government.
4.
(S/NOFORN/WNINTEL)
I
further
consent
to
participate
in
any
noninstrusive
biomonitoring
activities
that
are
necessary
for
project mission accomplishment.
5.
(U)
I hereby acknowledge
receiving
formal counseling concerning
my
assignment
to
DSSP.
Basic
training
and
operational
procedures
and
their
purposes,
as
well
as
attendant
discomforts,
risks,
and
benefits
have
been explained
to
me.
I
understand
that
I
may
at any
time
ask
questions
of
the
Commander,
POG,
or
other
appropriate
project
personnel
relating
to
areas
unclear
to
me.
I
further
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.
POSITION
POSITION
Approved For Release 200
-00789R0026001 60022-3
Approved For Release 2000/08/08
: CIA-RDP96-00789R0026001 60022-3
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.
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 2000/08/08
: CIA-RDP96-00789R0026001 60022-3