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  STATEMENT OF CONSENT
  DIA SUN STREAK PROJECT PARTICIPANT
  Date:
  (S1N0F0RN1VT1QINTEL) 1, volunt-ar j 1y
  ~~lccept assignf-ilent. to the DIA SUN STREAK PROJECT (DSSP) and fully
  underst-and that:
  a. (S/N0FORN/V7N1N1TEL) The DIA and DoD General Counsels have-
  determined that the DSSP constitutes experimentation on humo-n
  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
  -i.r)tel-lioeiic(?/cotiiiterintelligence operations throuqh the Use of
  u,sychoene-roetics rniethodology. Development of DSSP will be
  accoimplished with special training based on mission requirements.
                   1c. (C 7- F- n I -s Ji I~SSP coverned bv the
        sensitivity and degree of expertise required for the position. I
   ,%owe will be assianed in accordance with my capabilities and experience,
  regard1ri,ss of my rank. or prc-vicus osition. Due to the nature of
  P 1
  training involved, tlhe- durLtion of mly participation is irdefinit-.
  Records of my involveirent will be availal--le to project p s o n n e I
  but othervise protected under project security measures.
             vi-.
  d. (C/NOFORN) he primarv consideration in anv 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) PSYCPOENERGETICS (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, psychological
  and/or damaqe 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.
        ,%wool FOT R-t7,ViSADLE TO YORPj W. VAT101~11,LS
  V
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   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.
   it . (S/NOFORN/WNINTEL) I further consent to participate in any
   noninstrusive biomonitoring activities that are necessary for
   project mission accomplishment.
   (U) I hereby acknowledge receiving formal counseling concerning
   riy assignment to DSSP. Basic training and operational procedures
   and their purposes, as well as attendant discomforts, risks, and
   e." b (
   benefits hav ' --en explained to me. I understand that I may at any
   'rir-cie ask cTucstions of the Commtiander, POG, or other alpproPriate
   'OE-0ject personnel relating to areas unclear to me. I further
   I
   understand that my participation in DSSP is voluntary and that at i..y
   request I may at any time be reassigned without fear of adverse
   personnel action.
   SIGNATURE:
   Signature (Witness)
   Name, Rank/Grade
   So6-1al Security Number
   SIGNATURE:
   Signature (Participant)
   Name, Rank/Grade
   Social Security Number
        POSITION POSITION
   111111111;~W~1~ I
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 DATA REQUIRED BY THE PRIVACY ACT OF 1974 (5 U.S.C. 552a)
 I . 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 eXeCL]ted 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.
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