Approved For Release 2000/t&fr|d^XgftPP»fr<g789R0026001 6001 4-2
DEFENSE INTELLIGENCE AGENCY
WASHINGTON, D.C. 20301-6111
STATEMENT OF CONSENT
DIA SUN STREAK PROJECT PARTICIPANT
25X9A5
Date:
1.
(S/NOFORN/WNINTEL
accept
assignment
to
understand
that:
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.
voluntarily
and
fully
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
psychoener get ic methodology.
Development
of
DSSP
personnel
will
e
accompl. i shed with
special
training based
on mission
requirements.
c.
(C/NOFORN)
Assignments
in
DSSP.
are
governed
by
the
sensitivity
and
degree
of
expertise
required
f.or.
the
position,
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.
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
organ i sms
.
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
Approved For Release 2006/M/^:%M^^
Approved For Release 2
<
789R0026001 6001 4-2
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
nonintr us ive 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.
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.
25X9A5
Number
25X9A5
Signature
:
sy 0
{
0*k [
^
tin i tf/Or ganization
Posit .ion
Approved For Release 2000/08/08
: CIA^tQ£|(|
R0026001 6001 4-2
a
Approved For Release 200
00789R0026001 6001 4-2
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 2000/08^^
^A^^
|
Og|P0026001 6001 4-2