Rproved For Release 2000/08/08 : CIA-RDP96-00789R002100270010-9 a: DEFENSE INTELLIGENCE AGENCY WASHINGTON OC £63016" STATEMENT OF CONSENT DIA SUN STREAK PROJECT PARTICIPANT Date: l. . (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 DSSP 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. I 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. I 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 CH ANNELS ONLY TO UM ANNE LS ONLY Approved For Release 2000/08/08 : CIA-RDP96-00789R002100270010-9 SECRET
« — * Approved For Release 2000/08/08 : CIA-R 1: oorsenoceto0z70010- enofor camape to perticipants' reputation) to project personnel bevond risks #o whe ch they would ordinarily be exposed in their daily Lives How. oT, I understand further that potential for Irtury Cun Bg DSSi vlated activities cannot be conclusively ruled {. fF Ga> J ...2 temporarily choose not to particpate in the pesajeel at specifi.  imes, or permanently discontinue participation wif yore prejudice a’ ffect. Termination or temporary declination ad be «fected te Sotifying the Commander, POG, DSSP or his dexignet.? repres ." "ive. 2 (S/SK) As eS fetpene in DSSP, and IAW DoD 5240.1-R, I consent tu video . ~':s audio recording, monitor ing and transcribing of alt training - operational interviews in whi I am in any way involve: 2o8 part | “he DSSP mission. I understand that these recov. 8s ‘are shjce> to being monitored and/or transcribed by thica po fies Wot “th orwise involved in operations or training. Ree CF, /NOFORN) 1 ihe ..¥ acknowledge receiving separate counseling Comes ring my arse cement Co DSSP. Fundamental training and specacional te -ocedures and their purposes, as well as any attendant 4iscomfarce, risks, and benefits have been explained to me. “Stgnecure (Witness) ~ "Signature (Participant) en "Rane, Rank/Grade Name, Rank/Grade eg pe oe . 7 “Soctel Security Number . Social Security Number DATA REQUIRED BY THE PRIVACY ACT OF 1974 (5 U.S.C. 552a) L. Authority: ‘Yitte 10, U.S.C. Section 8012; Title 44, U.S.C., section 210% and <C 9297. 2. Principal Purpose: To maintain a record of those individuals who have executed statemenis of informed consent as participants in DSSP Re ~ Lad . Routine Uses The Secial Security Number is to be used to identify. the inviv! idua+, and the information is to be retained itictly within th progesa he Manlatery or Voiunticy Disclosure: Information is disclosed on é yolyntary basis, but withholding information will render it imposstble ic grent 1 facividual access to or participation in the prozram. , Approved For Release 2000/08/08 : CIA-RDP96-00789R002100270010-9 QOCPCT