(
  roved For Release 2000108108 : CIA-RDP96-00789ROO2100270010-9
  D
  DEF t-tq~,r INTELLIGENCL AGENCY
  V~A;~IINGTON L)C 2031~)l C,,ij
  -~, N-0
  STATEMENT OF CONSENT
  DIA SLIN STREAK PROJECT PARTICIPANT
  Date:
  (S/SK) 1, voluntarily accept
  assignment to t6e DIA SUN STREAK PROJECT (DSS ) 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-P.
       deF b. (C/NOFORN) Assignments in DSSP are governed by the type and
  ,ree of expertise required for the position, and are made
  according to individual capability and experience, regardless of
  rank or previous position. 1 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
  DECLA SSIFY ON OADR
  H A N D L E V I A S K E ET C H A N N E L S 0 N L Y
  Approved For Release 2000108/QA: CIA-RDP96-00789ROO2100270010-9
  S, F G R T

                                             
                                             

Approved For             Release 200D/08/08  
                         : CIA-RDP96-00789ROO2100270010-9
                                             

,,7,no,1r)r t~D          p,rticipantsl reputation)
                         to project personnel
                                             

y o n e. r ;"K S W       h ch they would ordinarily
                         be exposed in their 
                                             

i ly I ves Nov           . ~-r, I understand 
                         further that potential
                         for                 
                                             

i ur S S i               activities cannot   
                         be conclusively     
                         ruled               
                                             

                                             
                                             

                         temporarily choose  
                         not to particpate   
                         in the              
                                             

e c cff"                 ,~ imes, or permanently
                         discontinue participation
                                             

)01" L 't'iud i          I' f fect Termination
                         or temporary declination
                                             

f e C                    1- --,otifying the  
                         Commander, POG,     
                         DSSP or his         
                                             

e 0; n t- r e r.         i ve.               
                                             

(Si'SK) A s              )4'~ icipant in DSSO,
                         and IAW DOD 5240.1-R,
                         I                   
                                             

P -w V i d e c           audio recording,    
                         monitorin and transcribing
                         A                   
                                             

f: i i n g               -)pi-rational interviews
                         in whi              
                         I am in any way     
                                             

~-~s part                ~Jje DSSP mission.  
                         I understand that   
                         these               
                                             

recov.                   to being monitored  
                         and/or transcribed  
                         by                  
                                             

t I r ei, ~,al & n,~     i".,iise involved   
                         in operations or    
                         training.           
                                             

                                             
-ORN"                    acknowledge receiving
"NOr                     separate counseling 
                                             

my                       to DSSP. Fundamental
                         training and        
                                             

                                             
                                             
'- "and their purposes,                      
as well as any attendant                     
C                                            
p                                            
                                             

I i S c, o Tl f risk,.   , -.tnd benefits    
                         have been explained 
                         to me.              
                                             


-97-e-, T S
Signature (P;rticipant)
e, Rank/Grade
   116
.SOCIE-~
DATA rEQUIRED M THE PRIVACY
I . Autho-1- i C-: t 10, 11. S.C.
Sr,.-,.~tipn 11101 and ::C 9,~97.
        RanMrade
Name,
                                                    Social Security Number
ACT OF 1974 (5 U.S.C. 552a)
       1
Sect ion 8012; Ti tle 44, U. S.C. ,
2. Prin,,-ir",al Purpose: 7o maintain a record of those individuals
Who have e~iecuted of informed consent as participants in
,wt.iue Use- Th-.~ Scc-ial Sec
3. RQ urity Number is to be used to
identify, the inuiv1djp'~ ;ind the information is to be retained
sti'lctly v7fthin rfl, p r o e -?i
"ati-1EIL'Ory Or V~' Liunt-,.-. Disclosure: information is disclosed on
t4
volunt:-4-ry basis, bor oithholding information will render it
p Ti
      access to or participation in the
r 0 6, r 3 M"
Approved For Release 2000/08/08 CIA-RDP96-00789ROO2100270010-9
Pr. 0 PT