GRILL FLAME VOLUNTEER CONSENT STATEMENT (NANCY K. STOUT)

CIA-STARGATE

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The document is a consent statement for a volunteer, named "dyC~ G7", who wishes to participate in the INSCOM Project Grill Flame, a program designed to enhance psychic abilities. The volunteer agrees to undergo training and participate in intelligence projects using their psychic abilities. They understand that the training involves mental perceptive abilities beyond the five senses and that the purpose is to discipline and focus these abilities on data beyond the five senses. The volunteer also acknowledges that they can withdraw from the program at any time without controversy. Additionally, the document mentions the requirement for a Class A physical exam and stress EKG prior to training. The second part of the document pertains to the Privacy Act of 1974, stating that the purpose is to maintain records of individuals who have accessed Grill Flame information using their names and/or Social Security Numbers. The information is to be kept within the program and disclosure is voluntary but necessary for access or participation.

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Body:  Approved For Release 2001/03107.:..CIA-l DP96-00789R002100150078-8
 GRILL FLAME VOLUNTEER CONSENT STATEMENT
 SGFOIA3
 I,       dyC~                 G7
 NAME
 volunteer for INSCOM Project Grill Flame.  I understand this program involves
 training designed to enhance inherent psychic abilities.  I consent to this
 training and willingly volunteer to participate in INSCOM intelligence
 projects using my psychic abilities.  I understand this program deals with
 mental perceptive abilities beyond the range of the five corporal senses
 and for this reason an aspect of mental training is involved.   I understand
 that the purpose of this training is to teach me how to discipline my
 mental perceptive abilities and focus them on data beyond the range of the
 five corporal senses.
 I understand that as a volunteer I may withdraw from the program at
 any time for any reason.   My decision to withdraw from the program will be
 accepted without controversy.
 I understand that for precautionary and screening reasons that I as
 a GRILL FLAME volunteer must have a Class A physical exam to include a
 stress EKG prior to beginning training.
 NOTE:  Physical examination taken within the past 12 months is acceptable.
 WITNESS                                VOLUNTEER
 n
 Approved For Release 26 d /03107=: C lA-RDP96-00789R002100150078-8
 Approved For Release 2001/03/07 : CIA-RDP96-00789R002100150078-8
 DATA REQUIRED BY THE PRIVACY ACT OF 1974
 (5 U.S.C. 552a)
 1.   Authority:   National Records Act, L   U.S.C. 3102; E.O. 9397, Numbering
 System, for Federal Accounts Relating to Individual Persons, November 22, 1943.
 2.   Principal Purpose:   To maintain a record of those individuals who have
 or have had access to GRILL' FLAME information through the use of their name
 and/or 'Social Security Number.
 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.
 h.   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 2001/03/07 : CIA-RDP96-00789R002100150078-8