Approved For Release, 2000/08/01~.,"-RDP96-00792ROO0600160004-1
      1. (SINFIWN) I,
      assignment to the
      that:
      Date:
           DEFENSE INTELLIGENCE AGENCY 5W
      WASHINGTON, D.C. 20340-
      STATEMENT OF CONSENT
      DIA STAR GATE PROJECT PARTICIPANT
      - voluntarily accept
      DIA STAR GATE Project and fully understand
           a. (SINFIWN) The DIA and DoD General Counsels have
      determined that the STAR GATE Project constitutes experimentation
      on human subjects. As required by Procedure 13 ot DoD Directive
      5240.1-R, approval for project activities has been granted by the
      Deputy Secretary of Defense.
           b. (SINFIWN) The aim of STAR GATE is to develop highly
      skilled personnel who are capable of conducting professional
      level iiitelligence/counterintelligence operations through the use
      of psychoenergetics methodology. Development of STAR GATE will
      be accomplished with special training based on mission
      requirements.
           C. (C/NF) Assignments in STAR GATE 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. (CINF) The primary consideration in any career
      development or assignment action will be STAR GATE mission and
      operational requirements. I understand that exemption,
      interruption, or delay in normal career development patterns--
      such as branch schooling and assignment opportunities--nay
      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
      organisms.
           a. (U) I understand that while there is no demonstrated risk
      of permanent or temporary injury (including physical,
      WARNING NOTICE-INTELLIGENCE
      SOURCES OR METHODS INVOLVED
      CLASSIFIED BY MULTIPLE SOURCES
      DECLASSIFY ON OADR
                           Approved For Release 2000/08/0%~."-~RDP96-00792ROO0600160004-1
      lj_~110
      NOT RELEASABLE TO FOREIGN NATIONALS

      
          Approved For Release 20001081QAi"W- DP96-00792ROO0600160004-1
          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.
               b. (SINFIWN) 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 STAR GATE Manager or in his absence,
          his designated acting STAR GATE Manager.
          3. (SINFIWN) As a participant is STAR GATE, 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 STAR GATE mission. I
          understand that these recording 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 inconjunction with
          STAR GATE, with the understanding that these tape recordings and
          transcripts are property of the United States Government.
          4. (SINFIWN) I further consent to participate in any
          noninstrusive biomonitoring activities that are necessary for
          project mission accomplishment.
          5. (U) I hereby acknowledge receiving formal counseling
          concerning my assignment to STAR GATE. 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
          STAR GATE is voluntary and that at my request I may at any time
          be reassigned without fear of adverse personnel action.
          SIGNATURE: SIGNATURE:
          Signature (Witness)
          Signature (Participant)
          Name, Rank/Grade
          Social Security Number
          Name, Rank/Grade
          Social Security Number
          Position Position
          WARNING NOTICE-INTELLIGENCE
          SOURCES OR METHODS INVOLVED
             Approved For Release 2000/08/094me,pmr~MP'.%,Tiz;TWR-PP96-00792ROO0600160004-1
          NOT RELEASABLE TO FOREIGN NATIONALS