1. LAST NAME, FIRST NAME (AND ALIAS OR CODE NAME IF APPLICABLE) 2.

PROFESSION (RANK IF APPLICABLE)

PERSONAL DATA

Travis C. Grand Doctor of Medicine

3. EMPLOYER 4. NATIONALITY
Shriners Hospitals for Children - Boston American
5. SEX 6. AGE AND D.O.B. 7. EDUCATION AND OCCUPATIONAL HISTORY
 F ✔
 M  48

8. STATISTICS SCORE ×5 DISTINGUISHING FEATURES 11. BONDS SCORE

Strength (STR) 10 50 Freemasonry (Group) 12

Constitution (CON) 11 55 Colleagues (Shriners Hospital) 12
Dexterity (DEX) 14 70 Church (Group) 12

PSYCHOLOGICAL DATA
Intelligence (INT) 16 80
Power (POW) 14 70
STATISTICAL DATA

Charisma (CHA) 12 60
9. DERIVED ATTRIBUTES MAXIMUM CURRENT 12. MOTIVATIONS AND MENTAL DISORDERS

Hit Points (HP) 10 Adapted to Helplessness

Being adapted to Helplessness means your Agent’s
Willpower Points (WP) 14 personal drive suffers. As soon as your Agent
Sanity Points (SAN) 70 65 becomes adapted to Helplessness, he or she
permanently loses 1D6 POW.
Breaking Point (BP) 56
10. PHYSICAL DESCRIPTION
Standing 6' 2" tall, and muscular with brown skin, Travis 13. INCIDENTS OF SAN LOSS WITHOUT GOING INSANE
has a resilient feel about him.
Violence    adapted Helplessness    adapted
He has an oval face with a rounded jaw, a flat nose, full
lips, and his brown eyes are prominent.
Accounting
 black
His (10%)
hair is short and is lightly gelled. First Aid (10%) 60  Ride (10%)
He usually wears practical clothes that are mostly
 Alertness (20%)  Forensics (0%) 50  Science (0%):
dark-coloured and loose, and he wears a earring in one 60
ear.
 Anthropology (0%)  Heavy Machinery (10%) Biology

 Archeology (0%)  Heavy Weapons (0%)  Search (20%) 40

 Art (0%):  History (10%)  SIGINT (0%)

 HUMINT (10%) 50  Stealth (10%)

 Artillery (0%)  Law (0%)  Surgery (0%) 50

APPLICABLE SKILL SETS

 Athletics (30%)  Medicine (0%) 80  Survival (10%) 50

 Bureaucracy (10%) 50  Melee Weapons (30%)  Swim (20%)

 Computer Science (0%)  Military Science (0%):  Unarmed Combat (40%)

 Craft (0%): Unnatural (0%)

 Navigate (10%) Foreign Languages and Other Skills:

 Criminology (10%)  Occult (10%) 20 

 Demolitions (0%)  Persuade (20%) 60 

THIS IS A WORK OF FICTION

 Disguise (10%)  Pharmacy (0%) 70 

 Dodge (30%)  Pilot (0%): 

 Drive (20%) 40 

 Firearms (20%)  Psychotherapy (10%) 

Check a box when you attempt to use a skill and fail. After the session, add 1 to each checked skill and erase all checks.
 14. WOUNDS AND AILMENTS

INJURIES

Has First Aid been attempted since the last injury?  yes: only Medicine, Surgery, or long-term rest can help further

15. ARMOR AND GEAR

EQUIPMENT

Body armor reduces the damage of all attacks except Called Shots and successful Lethality rolls.
16. WEAPONS SKILL % BASE RANGE DAMAGE ARMOR PIERCING LETHALITY % KILL RADIUS AMMO

(a)

(b)

(c)

(d)

(e)

(f)

(g)

17. PERSONAL DETAILS AND NOTES 18. DEVELOPMENTS WHICH AFFECT HOME AND FAMILY
Captivity or Imprisonment
Add +10% to your Agent’s Occult skill. Reduce SAN
by 5. Subtract 3 from your Agent’s POW. Your Agent
is Adapted to Helplessness (see page 73).
REMARKS

19. SPECIAL TRAINING SKILL OR STAT USED THIS IS A WORK OF FICTION

Please indicate why this agent was recruited and why the agent agreed to be recruited.

20. AUTHORIZING OFFICER 21. AGENT SIGNATURE

UNITED STATES
DD 315 112382
TOP SECRET//ORCON//SPECIAL ACCESS REQUIRED-DELTA GREEN
FORM
AGENT DOCUMENTATION SHEET