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    Approved For Release AUjpQLUp4j81: %;LQwmL)M-00789ROO26001 6nni 9-A
                              DEFENSE INTELLIGENCE AGENCY
                              WASHINGTON, D.C. 20301-6111
    STATEMENT OF CONSENT
    DTA SUN STREAK PROJECT PARTICIPANT
    SG1J Date: 2'~K PWAVe"A
                                                              I ~0
    1. (S/NOFORN/WNINTEL) I, voluntarily
    accept assignment to the DIA 57 and fully
    understand that:
         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. (C/NOFORN) Assignments in DSSP 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. (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 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 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
    Ir A7.,Jg*V:66 T I DECLAS: OADR
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    Approved For Releasebdfi*MIN&-knP96-00789ROO2600160012-4
         b (S/NOFORN/WNlNTEL) I may temporarily choose not to perform
    PE at specific times, or permanently discontinue participation
    without prejudicial effecL. Termination will be affected by
    notifying the J)SSP Manager or in his absence, his designated acting
    DSSP Manager.
    3. (S/NOFORN/WNINTEI,) As a participant in DSSP, and IAW
    I consent to tape recording, monitoring and transcribing of all
    operational and training interviews in which I nm involved as an
    integ art of the DSSP mission. I understand that these
    ,ral p,
    recordings --ire subject to being monitored and/or transcribed by
    third parties not otherwise involved in operations or training.
    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.
    11. .(S/NOFORN/WNINTFL) T further 'consent (-.o participate in any
    nonintrusive biomonitoring activities that are necessary for project
    mission accomplishment.
    5. (11) 1 hereby acknowledge
    my assignment to DSSP. Basic
    and their purposes, as well ~3s
    benefiLs have been explained to
    Lime ask questions of project
    me. I further understand that
    and that at. my request T may
    ofSGF&hP(& personnel action.
                         receiving formal counseling concerning
                          operational. and training procedures
         attendant discomforts, risks, and
    me. I understand that I may at any
    personnel relating to areas unclear to
    my participation in DSSP is voluntary
    it any time be reassigned without fear
    Sr-,FC)IA3
    OIA3
    Unit/Organization
    Position
    Unit/Organization
    Position
                      Approved For Release 200am QQ296-00789RO02600160012-4
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    cial Security Number

    
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Approved For Releast~~jiWM/bd~:~mfi!-RDP96-00789ROO2600160012-4
DATA REQUIRED BY THE PRIVACY ACT OF 1.974 (5 U.S.C. 552a)
1. Authority: Title 1.0, 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 indiVidL10l, 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 200PQ"§r%Ca fPI96-00789ROO2600160012-4

         Approved For Release 2000/08/08 : CIA-RDP96-00789ROO2600160012-4
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         Approved For Release 2000/08/08 : CIA-RDP96-00789ROO2600160012-4