STATEMENT OF CONSENT: DIA SUN STREAK PROJECT PARTICIPANT

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00789R002600160018-8
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 3
• Document Creation Date: November 4, 2016
• Document Release Date: December 4, 1998
• Sequence Number: 18
• Publication Date: March 28, 1985
• Content Type: CONT

Approved For Release 1131~-rRDP96-007898002600160018-8
DEFENSE INTELLIGENCE AGENCY
WASHINGTON, D.C. 203 01-6111
STATEMENT OF CONSENT
DIA StJN STREAK PROJECT FARTIGIPANT
SG1J
Date : ~,~ fYIG.-- ~ ~
]_. (S/NOFOP.N/WNINTEL) I, voluntarily
accept assignment to the DI nd 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/NOFOP~N/WNINTEL) The aim of the DSSP is to develop highly
skil7_ed personnel who are capable of conducting professional level
intell~.gence/counterintelligence operations through t.~se 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 a.nd 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.
ci. (C/NOFOR_N) 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
or~,anisms .
a. (IJ) I understand that while there is no demonstrated risk
of permanent or temporary injury (including physical, psychological
and./or da.tnage 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
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b. (S/NCIFORN/GTNINTI~:L) I may temporarily choose not to perform
PL' at specific times, c.~r permanently discontinue participation
without prejudicial effect. i'ermir~ation will be affected by
nc>tifyir~g the DSSP Mana,c;er or in his absence, his designated acting
17SSI? ;tanager .
3. (S/NOFQItN/WNINTEL) As a participant in DSSP, and IAW
I consent to tape recording, monitoring and transcribing of all
operational ai'~rl trainin~T, interviews in which I am involved as an
integral. part of the DSSP rryission. I understand that these
recordings are subject to laeing monitored and/or transcribed by
third. paY?ties not otherwise involved in operations or training. I
waive any claim or right o.f ownership to all tape recordings and
transcr.il.7ts made in conjunction with DSSP, with the understanding
that these tape recordings and transcripts are property of. the
United States Government.
4. (S/NOFORN/WNINTFL) I fux?ther'consent to participate in any
nonintrusive biomonit:oring activities that are necessary for. project
rrri.ssion accompl.shmer7t.
S. ([)) I hereby ackr7owlecl?,e receiving formal counseling concerning
my assignment to DSSP. Basic operational and training procedures
and them- purposes, as well as attendant discomforts, risks, and
benefits have been explained to me. I understand that I may at any
tame 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 rega.iest. T may at any -time be reassigned without :fear
o~~~~~r~e personnel act ion .
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 Approved For Relea 96-007898002600160018-8
DATA REQUIRED BY THE PRIVACY ACT OF 1974 ~5 U.S.C. 552x)
1. Authority: Title 10, U.S.C. Section 3012.
2. Principal Purpose: To maintain a record of those ind:ividual.s
who have executed statements of informed consent as participants in
DSSP.
3. Routine U:~es: The Social Security Number is to be used to
identify the individual, and the information is to be. retained
strictly within ttie program.
4. Mandatory or Voluntary Disclosure: Inforrnatian is disclosed on
a voluntary basis, but withholding information will render it
irnpossib~_e to grant an ir.~dividual. access to or participation. in the
program.
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