Approved For Release
b
023-2
STATEMENT OF CONSENT
DIA SUN STREAK PROJECT PARTICIPANT
1.
(S/NOFORN/WNINTEL)
accept
assignment
to
understand
that:
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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
j
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
j
intelliqence/counter intelligence
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
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 tunit ies--may
prejudice
I
future
promotion
and
assignment
potential.
I
have
been
assured,
!
however,
that
every
effort
will
be
made
to
preclude
the
adverse
j
effects
listed above
on my career.
j
2.
(U)
PSYCHOENERGETICS
(PE)
include
various
processes
by
which
j
individuals
psychically
interact
with
objects,
locations,
and
organisms.
(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.
KOI RELEASABLE 10 FOREIGN NATIONALS
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Approved For Release 2000/08/08
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Approved For Release 2000/08/08
: CIA-RDP96-00789R0026001 60023-2
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.
1 (S/NOFORN/WNINTEL)
I
further
consent
to
participate
in
any
non iristr 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
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.
SGI J
SGI J
SIGNATURE:
SGI J
SGI J
SIGNATURE:
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X
Y- L
Approved For Release 2000/08/08
: CIA-RDP96-00789R0026001 60023-2
Approved For Release 2000/08/08
: CIA-RDP96-00789R0026001 60023-2
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.
j
I
Approved For Release 2000/08/08
: CIA-RDP96-00789R0026001 60023-2