CIA-RDP96-00789R002600160014-2

OF
DEPAR
FENSE
NITED STATES OF
AM
CCCDCT
Approved For Release 2000/ 80OT-ADP16 00789R002600160014-2
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:
voluntarily
DSSP) 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.
c.
I
(C/NOFORN) Assignments in DSSP are governed by the
sensitivity and degree of expertise required for 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
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
Approved For Release 2000/08/08 -CIA-RDP96-00789R002600160014-2
FOREIGN NATIONALS DECLAS :
OADR
SECRET
WNINTEL

*
Approved For Release 2000 0g 18 : CIA: ROR96-00789R002600160014-2
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
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. 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
25X9A5
Signature:
ess
Number
SPD, MIBU(S) 9028 MIG
Unit/Organization
Position
Approved For Release 2000/08/08 : CIA-RDP96-00789R002600160014-2
SECRET

SECRET
Approved For Release 2000708/08 : CIA-RDP96-00789R002600160014-2
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 2000/08/08 : CIA-RDP96-00789R002600160014-2
SECRET