: Approved For Releas SPIE MEE MDESE.00789R002600160012-4 DEFENSE INTELLIGENCE AGENCY WASHINGTON, D.C. 20301-6111 STATEMENT OF CONSENT DIA SUN STREAK PROJECT PARTICIPANT SGtJ Date: AY pra 49 3~ 1. (S/NOFORN/WNINTEL) I, accept assignment to the DIA 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 13 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 use of psychoenergetic methodology. Development of DSSP personnel will be accomplished with special training based on mission requirements. Cc. (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 opportunities--may prejudice future promotion and assignment potential. JI have been assured, however, that every effort will be made to preclude the adverse effects listed above on my career. 2. (WU) 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. CLASSIFIED BY: DIA, DT HA TAD RT AN WATTON DECLAS: OADR
* Approved For ReleassSDtgrenk® fra kDP9s-00789R0026001 60012-4 b. (S/NOFORN/WNINTEL) I may temporarily choose not to perform PE 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 I consent to tape recording, monitoring and transcribing of all operational and training 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 nonintrusive biomonitoring activities that are necessary for project mission accomplishment. 5. (U) I hereby acknowledge receiving formal counseling concerning my assignment to DSSP. Basic operational and training 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 project personnel relating to areas unclear to me. - further understand that my participation in DSSP is voluntary and that at my request I may at any time be reassigned without fear ofSGRPO@WG personnel action. SGFOIA3 .., Sien SGFOIA3 Social Security Number Social securicy __ on _ Spd, MI bn(5), FO2k MIG Unit /Organization Unit /Organization Position oo ——POSition Approved For Release 200 : - 6-00789R00260016001 2-4
cers‘ mane ma i i sl asia . . Approved For releases RTA at nopse-co7e9R007800160012-4 DATA REQUIRED BY THE PRIVACY ACT OF 1974 (5 U.S.C. 552a) 1. Authority: Title 10, U.S.C. Section 3012. 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 200 ‘ 6-00789R00260016001 2-4
Approved For Release 2000/08/08 : CIA-RDP96-00789R002600160012-4 Ma ockon Llenon duct in Road. Approved For Release 2000/08/08 : CIA-RDP96-00789R002600160012-4