((OOC: Be sure you answer all questions as your character, and have fun with this. It may also help you to "know" your character better. And remember, only Stymie has access to your assessment "file," although Athena and/or Lonefire can order Stymie to disclose your "file" to them.))
Identifying Information:
1) Imperial ID # (OOC: just make one up):
2) Name:
3) Age:
4) Sex (male, female, asexual, other?):
5) Species:
6) Current Residence:
8) Military Rate (your job in the Empire):
9) Military Rank:
10) Career aspirations:
11) Force sensitive? (yes or no):
12) Self-reported ability to access The Force (on a scale of 1 [low] to 10 [high]):
13) Force affiliation (dark, light, grey, etc.):
14) Religious affiliation? (if applicable?Sith, Jedi, etc.):
15) List any WOSW organizations you may be a member of:
16) Educational level:
17) Relationship Status (single, significant other, married, divorced, etc.):
18)Occupation of significant other (if applicable):
19) How long have you been in this relationship? (if applicable):
20) Including yourself, how many people currently live in your household?:
21) If applicable, list all children?s names and ages (also indicate if they are stepchildren, adopted, foster):
22) On which planet were you born?:
23) On which planet were you raised?:
24)Who raised you and how were you related?:
25) List all siblings, including yourself, in order of birth (also indicate whether bio, step, half, etc.):
26) Is there anything else you would like me to know about your family?:
27) Is there any history of mental illness in your family?:
28) Are you currently taking any medication?:
29) If so, for what reasons and for how long?:
30) Have you ever been hospitalized for psychiatric treatment? yes or no:
31) If yes, when was it and how long were you in treatment?:
Current Challenges (Place an X next to all that apply):
a. Anger:
b. Finances:
c. Health:
d. Relationships difficulties:
e. Traumatic experience(s):
f. Anxiety:
g. Self-esteem and/or self blame (specify which):
h. Work-related problems:
i. Depression:
j. Grief:
k. Parenting difficulties:
l. Psychoses/Delusions/Hallucinations (specify which):
m. Adjustment to the Imperial lifestyle:
n. body image:
o. Learning disability:
p. Mood instability:
q. Substance use:
r. Alienation/isolation:
s. Low energy/fatigue:
t. Attention deficit and/or hyperactivity disorder (specify which):
Others not covered above (please list):
32) What happened that led you to seek therapy? (please be specific):
33) How long have you lived with this problem and what have you already tried to do about it?:
34) Have you received psychotherapy and/or psychiatric service before? If so, when and with whom?:
35) What do you consider to be your greatest strengths (inner qualities, talents, skills, etc.)?:
36) What do you consider to be your greatest weaknesses?:
37) Is there anything else that you think is important to discuss about your situation?:
Suicide Risk Assessment:
a. Presence of current suicidal thoughts or impulses? (yes or no):
b. If yes, do you have a specific suicidal plans? (yes or no):
c. If yes, provide details of your plan:
d. Do you have access to the means to carry out your plan? (yes or no):
e. Any history of previous suicide attempts? (yes or no):
f. If yes, please provide details:
Risk of Harm to Others:
a. Presence of thoughts or impulses to harm others (yes or no):
b. If yes, please provide details:
38) Relevant Social/Developmental History:
39) Relevant Medical Conditions/Medications:
http://tinyurl.com/Stymie-Intake
Updated January 3, 2009
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Name : Alfred Bester
Age : 40
Sex : Male
Species : Human
Current Residence : Private Home
Military Rate : Internal Security Bureau ( ISB )
Military Rank : Colonel
Career Aspirations : To serve the Empire to the fullest extent of my abilities.
Force Sensitive : Yes
Self - Reported ability to access the Force : 6
Force Affiliation : Dark Side
Religious Affiliation : Sith
Not a member of any other groups or organizations.
Educational Level : Top of class from Imperial Security Training Facility on Korriban.
Relationship Status : Single
How many people currently live in your household : 1
On what planet were you born ? : Coruscant
On what planet were you raised ? : Coruscant
Who raised you and how are you related ? : Matthew & Delia Bester , Aunt & Uncle
No siblings.
Aunt and Uncle both served the Empire in the COMPNOR Branch and are now retired with Honorable Discharge.
No mental illness in family.
Not taking any medication.
Never been hospitalized for psychiatric treatment.
I have no current challenges.
My greatest asset is my mind which has served me well. I am cool and calculating and approach all matters with an open mind.
No weaknesses that I am aware of.
Suicide Risk Assessment:
a. Presence of current suicidal thoughts or impulses? (yes or no): no
b. If yes, do you have a specific suicidal plans? (yes or no):
no
c. If yes, provide details of your plan:
d. Do you have access to the means to carry out your plan? (yes or no):
e. Any history of previous suicide attempts? (yes or no):No
f. If yes, please provide details:
Risk of Harm to Others:
a. Presence of thoughts or impulses to harm others (yes or no): No
b. If yes, please provide details:
38) Relevant Social/Developmental History: None to date
39) Relevant Medical Conditions/Medications: None.
2) Name:Anakin Skywalker
3) Age: 22
4) Sex male
5) Species: human
6) Current Residence: Sith Temple
8) Military Rate (your job in the Empire):Sith Lord
9) Military Rank:
10) Career aspirations:Kill any exisiting jedi
11) Force sensitive? yes
12) Self-reported ability to access The Force (on a scale of 1 [low] to 10 [high]): 10
13) Force affiliation dark
14) Religious affiliation? sith
15) List any WOSW organizations you may be a member of: The empire
16) Educational level:high
17) Relationship Status (single, significant other, married, divorced, etc.): single
18)Occupation of significant other (if applicable):Sith Lord
19) How long have you been in this relationship? (if applicable): none
20) Including yourself, how many people currently live in your household?:1
21) If applicable, list all children?s names and ages (also indicate if they are stepchildren, adopted, foster):Luke Skywalker Leia Organa
22) On which planet were you born?: Tatooine
23) On which planet were you raised?:Tatooine
24)Who raised you and how were you related?:Shmi Skywalker mother
25) List all siblings, including yourself, in order of birth (also indicate whether bio, step, half, etc.):Owen Lars Stepbrother
26) Is there anything else you would like me to know about your family?:
27) Is there any history of mental illness in your family?:none
28) Are you currently taking any medication?:none
29) If so, for what reasons and for how long?:none
30) Have you ever been hospitalized for psychiatric treatment? yes or no: no
31) If yes, when was it and how long were you in treatment?:
Current Challenges (Place an X next to all that apply):
a. Anger:
b. Finances:
c. Health:
d. Relationships difficulties:
e. Traumatic experience(s):
f. Anxiety:
g. Self-esteem and/or self blame (specify which):
h. Work-related problems:
i. Depression:
j. Grief:
k. Parenting difficulties:
l. Psychoses/Delusions/Hallucinations (specify which):
m. Adjustment to the Imperial lifestyle:
n. body image:
o. Learning disability:
p. Mood instability:
q. Substance use:
r. Alienation/isolation:
s. Low energy/fatigue:
t. Attention deficit and/or hyperactivity disorder (specify which):
Others not covered above (please list):
32) What happened that led you to seek therapy? (please be specific): had 2 cause it said in the enlistment requirements for the emprie
33) How long have you lived with this problem and what have you already tried to do about it?:
34) Have you received psychotherapy and/or psychiatric service before? If so, when and with whom?:none
35) What do you consider to be your greatest strengths (inner qualities, talents, skills, etc.)?: force abilities
36) What do you consider to be your greatest weaknesses?: I have no idea
37) Is there anything else that you think is important to discuss about your situation?:
Suicide Risk Assessment:
a. Presence of current suicidal thoughts or impulses? (yes or no): no
b. If yes, do you have a specific suicidal plans? (yes or no):
no
c. If yes, provide details of your plan:
d. Do you have access to the means to carry out your plan? (yes or no):
e. Any history of previous suicide attempts? (yes or no):
f. If yes, please provide details:
Risk of Harm to Others:
a. Presence of thoughts or impulses to harm others (yes or no):yes
b. If yes, please provide details: I'm a sith lord I kill people
38) Relevant Social/Developmental History:
39) Relevant Medical Conditions/Medications:
2) Name: Nick Owabi
3) Age: 32
4) Sex (male, female, asexual, other?): Male
5) Species: Human
6) Current Residence: Throne Room/Elom
8) Military Rate (your job in the Empire): Imperial Moff
9) Military Rank: Imperial Moff
10) Career aspirations: Military Governorship
11) Force sensitive? (yes or no): Yes
12) Self-reported ability to access The Force (on a scale of 1 [low] to 10 [high]): 8
13) Force affiliation (dark, light, grey, etc.): Grey
14) Religious affiliation? (if applicable?Sith, Jedi, etc.): Sith
15) List any WOSW organizations you may be a member of: New JedI Order, Knights of Ashla, Grey JedI Order, Reconstructed Galactic Empire
16) Educational level: Imperial Military Academy
17) Relationship Status (single, significant other, married, divorced, etc.): Married
18)Occupation of significant other (if applicable):New Republic Operations Intelligence
19) How long have you been in this relationship? (if applicable): March 19, 2008 (OOC Date wedding took place. IC 7 yrs.)
20) Including yourself, how many people currently live in your household?: 4
21) If applicable, list all children?s names and ages (also indicate if they are stepchildren, adopted, foster): Jael Owabi, 12 yrs old (Stepdaughter); Jaems Owabi, 7 yrs old (Son)
22) On which planet were you born?: Earth
23) On which planet were you raised?: Coruscant
24)Who raised you and how were you related?: Logan and Allison Macintyre (parents)
25) List all siblings, including yourself, in order of birth (also indicate whether bio, step, half, etc.): Nick Owabi (me)
26) Is there anything else you would like me to know about your family?: Noble lineage on Earth
27) Is there any history of mental illness in your family?: None
28) Are you currently taking any medication?: No
29) If so, for what reasons and for how long?: N/A
30) Have you ever been hospitalized for psychiatric treatment? yes or no: No
31) If yes, when was it and how long were you in treatment?: N/A
Current Challenges (Place an X next to all that apply):
a. Anger: X
b. Finances:
c. Health:
d. Relationships difficulties:
e. Traumatic experience(s): X
f. Anxiety:
g. Self-esteem and/or self blame (specify which):
h. Work-related problems:
i. Depression:
j. Grief: X
k. Parenting difficulties:
l. Psychoses/Delusions/Hallucinations (specify which):
m. Adjustment to the Imperial lifestyle:
n. body image:
o. Learning disability:
p. Mood instability:
q. Substance use:
r. Alienation/isolation:
s. Low energy/fatigue:
t. Attention deficit and/or hyperactivity disorder (specify which):
Others not covered above (please list):
32) What happened that led you to seek therapy? (please be specific): I thought that my wife had been killed in a shuttle explosion but it turned out that she was on a top secret mission for the New Republic Operations Intelligence Division and faked her own death without telling me.
33) How long have you lived with this problem and what have you already tried to do about it?: Several months. I have not tried anything.
34) Have you received psychotherapy and/or psychiatric service before? If so, when and with whom?: No
35) What do you consider to be your greatest strengths (inner qualities, talents, skills, etc.)?: Diplomacy, Leadership, Passionate about duties, Marksman Rifle and Blaster, Expert Pilot, Empathic, Determined, Strong Minded, Intelligent
36) What do you consider to be your greatest weaknesses?: Impatient, Lack Swordsman training, Sometimes act before I think
37) Is there anything else that you think is important to discuss about your situation?: No
Suicide Risk Assessment:
a. Presence of current suicidal thoughts or impulses? (yes or no): No
b. If yes, do you have a specific suicidal plans? (yes or no): No
c. If yes, provide details of your plan:
d. Do you have access to the means to carry out your plan? (yes or no): No
e. Any history of previous suicide attempts? (yes or no): No
f. If yes, please provide details:
Risk of Harm to Others:
a. Presence of thoughts or impulses to harm others (yes or no): No
b. If yes, please provide details:
38) Relevant Social/Developmental History: I have been known to barge into battle recklessly without thinking at times about the safety of my troops. I hope to rectify this.
39) Relevant Medical Conditions/Medications: Currently have two cybernetic legs, cybernetic eyes with a built in HUD. Lost both arms in a battle at the old JedI Enclave on Dantooine. Were replaced with Bionic arms and then later re-grown naturally through the Force.
2) Name: Tulak Hord
3) Age: 34
4) Sex: Male
5) Species: Human/Sith Mandalorian
6) Current Residence: Wayland
8) Military Rate: Diplomat
9) Military Rank: N/A
10) Career aspirations: Diplomatic Affairs Council to the Empress
11) Force sensitive? Yes, only as a result of Sith Lineage
12) Self-reported ability to access The Force: 6 (only able to access the force for lightsaber combat/ manipulation abilities)
13) Force affiliation: Dark
14) Religious affiliation? Sith
15) List any WOSW organizations you may be a member of:
16) Educational level: Post Graduate Studies Psycholody and Civic Specilization. Apprenticed under Jorus C?Baoth and Count Dooku for 26 years: Lightsaber specilization
17) Relationship Status: Single
18)Occupation of significant other: N/A
19) How long have you been in this relationship?: N/A
20) Including yourself, how many people currently live in your household?: 1
21) If applicable, list all children?s names and ages : N/A
22) On which planet were you born?: Myrkr
23) On which planet were you raised?: Wayland
24)Who raised you and how were you related?: Adopted and raised by Jorus C?Baoth
25) List all siblings, including yourself, in order of birth: N/A
26) Is there anything else you would like me to know about your family?: My adopted father Jorus C?Baoth was a clone of a Jedi Master Jorus C?Baoth who had The tell-tale side effects of mental instability and self-name mispronunciation
27) Is there any history of mental illness in your family?: Not heridtary
28) Are you currently taking any medication?: No
29) If so, for what reasons and for how long?: N/A
30) Have you ever been hospitalized for psychiatric treatment? yes or no: No
31) If yes, when was it and how long were you in treatment?: N/A
Current Challenges (Place an X next to all that apply):
a. Anger: X
m. Adjustment to the Imperial lifestyle: X
r. Alienation/isolation: X
s. Low energy/fatigue:
t. Attention deficit and/or hyperactivity disorder (specify which):
Others not covered above (please list):
32) What happened that led you to seek therapy? : Induction into the Reconstructed Galatic Empire
33) How long have you lived with this problem and what have you already tried to do about it?:
34) Have you received psychotherapy and/or psychiatric service before? If so, when and with whom?: NO
35) What do you consider to be your greatest strengths: Problem Solving, Intra Personal Communication, Lightsaber Awareness / Character Assesment
36) What do you consider to be your greatest weaknesses?: Blinding Rage under duress and in combat / Trust of others
37) Is there anything else that you think is important to discuss about your situation?: N/A
Suicide Risk Assessment:
a. Presence of current suicidal thoughts or impulses? : No
b. If yes, do you have a specific suicidal plans? : No
c. If yes, provide details of your plan: N/A
d. Do you have access to the means to carry out your plan?: N/A
e. Any history of previous suicide attempts? No
f. If yes, please provide details:N/A
Risk of Harm to Others:
a. Presence of thoughts or impulses to harm others: Yes
b. If yes, please provide details: Conflict not resolved initially by diplomacy turns quickly to violence and threats of murder. If the subject does not submit with violence retribution usually extends beyond him/her to their immediate family
38) Relevant Social/Developmental History: N/A
39) Relevant Medical Conditions/Medications: N/A
2) Name: Gabriel Volker
3) Age: 45
4) Sex (male, female, asexual, other?): Male
5) Species: Human
6) Current Residence: Dathomir
8) Military Rate (your job in the Empire):Imperial Moff
9) Military Rank: Imperial Moff of the Quelii Sector
10) Career aspirations: To follow and carry out the orders of the Empress, and possibly one day become Grand Moff or achieve a higher ranking.
11) Force sensitive? (yes or no): Yes
12) Self-reported ability to access The Force (on a scale of 1 [low] to 10 [high]): 10
13) Force affiliation (dark, light, grey, etc.): Dark
14) Religious affiliation? (if applicable?Sith, Jedi, etc.): Sith
15) List any WOSW organizations you may be a member of: Galactic Senate, Reconstructed Galactic Empire
16) Educational level: College (Medical)
17) Relationship Status (single, significant other, married, divorced, etc.): Married
18)Occupation of significant other (if applicable): My Aid
19) How long have you been in this relationship? (if applicable): about 2 years
20) Including yourself, how many people currently live in your household?: 3
21) If applicable, list all children?s names and ages (also indicate if they are stepchildren, adopted, foster): We have 1 beautiful daughter named Corde' and 1 son on the way we have named Gabriel II
22) On which planet were you born?: Corellia
23) On which planet were you raised?: Coruscant
24)Who raised you and how were you related?: For the first 4 years my parents Saul and Derallia Volker raised me, after that the Jedi Order raised me till I was about 25 or so.
25) List all siblings, including yourself, in order of birth (also indicate whether bio, step, half, etc.):Gabriel Volker: (Self), Jadon Masters (self name change): (Biological), Vincent Volker (Biological)
26) Is there anything else you would like me to know about your family?: No
27) Is there any history of mental illness in your family?: No
28) Are you currently taking any medication?: No
29) If so, for what reasons and for how long?: N/A
30) Have you ever been hospitalized for psychiatric treatment? yes or no: No
31) If yes, when was it and how long were you in treatment?: N/A
Current Challenges (Place an X next to all that apply):
a. Anger: X
b. Finances:
c. Health:
d. Relationships difficulties:
e. Traumatic experience(s): X
f. Anxiety:
g. Self-esteem and/or self blame (specify which):
h. Work-related problems:
i. Depression:
j. Grief:
k. Parenting difficulties:
l. Psychoses/Delusions/Hallucinations (specify which):
m. Adjustment to the Imperial lifestyle:
n. body image:
o. Learning disability:
p. Mood instability: X
q. Substance use:
r. Alienation/isolation:
s. Low energy/fatigue:
t. Attention deficit and/or hyperactivity disorder (specify which):
Others not covered above (please list):
32) What happened that led you to seek therapy? (please be specific): Imperial regulations mandate it
33) How long have you lived with this problem and what have you already tried to do about it?: I have been a Dark Jedi since around the Yuuzong Vong invasion when as a Jedi I and my former apprentice and lover were abandoned by the team of Jedi I was leading and left for dead. I eventually was redeemed and returned to the Jedi but soon after was betrayed by another Jedi and opted to return to my old ways.
34) Have you received psychotherapy and/or psychiatric service before? If so, when and with whom?: No
35) What do you consider to be your greatest strengths (inner qualities, talents, skills, etc.)?: My skills with the lightsaber, I have mastered forms II: Makashii and V: Shien/Djem So. My attunedness to the force. My love for my family. And my devotion to the Empire and its Empress. Loyalty is another one of my strengths. I will stand by a cause and give my life for it should the need arise.
36) What do you consider to be your greatest weaknesses?: My inability to control my anger, My family (without them I would cease to exist.)
37) Is there anything else that you think is important to discuss about your situation?: My life revolves around my wife and children everything I do, I do for them. So if any threat comes to them, I would lose control of myself and lay waste to anything that got in my path.
Suicide Risk Assessment:
a. Presence of current suicidal thoughts or impulses? (yes or no): No
b. If yes, do you have a specific suicidal plans? (yes or no): N/A
c. If yes, provide details of your plan: N/A
d. Do you have access to the means to carry out your plan? (yes or no): N/A
e. Any history of previous suicide attempts? (yes or no): N/A
f. If yes, please provide details: N/A
Risk of Harm to Others:
a. Presence of thoughts or impulses to harm others (yes or no): Yes
b. If yes, please provide details: I have a very short fuse. When angered I am quick to lash out. When betrayed by a former Jedi I went after his wife for revenge, than later went after him. Also after I returned to the Sith order the second time I took an apprentice, and as a way for him to prove his loyalty I had him assassinate his former master and my lover at the time.
38) Relevant Social/Developmental History: N/A
39) Relevant Medical Conditions/Medications: N/A
2) Name: Darth Urimash
3) Age: 21
4) Sex (male, female, asexual, other?): Male
5) Species: Human
6) Current Residence: None
8) Military Rate (your job in the Empire): Ground Forces
9) Military Rank: Private
10) Career aspirations: Strategist
11) Force sensitive? (yes or no): Yes
12) Self-reported ability to access The Force (on a scale of 1 [low] to 10 [high]): 5
13) Force affiliation (dark, light, grey, etc.): Dark
14) Religious affiliation? (if applicable?Sith, Jedi, etc.): Sith
15) List any WOSW organizations you may be a member of: None
16) Educational level: College Level
17) Relationship Status (single, significant other, married, divorced, etc.): None
18)Occupation of significant other (if applicable): None
19) How long have you been in this relationship? (if applicable):
20) Including yourself, how many people currently live in your household?:
21) If applicable, list all children?s names and ages (also indicate if they are stepchildren, adopted, foster):
22) On which planet were you born?: Shumari
23) On which planet were you raised?: Coruscant
24)Who raised you and how were you related?: Unknown. Not related
25) List all siblings, including yourself, in order of birth (also indicate whether bio, step, half, etc.):
26) Is there anything else you would like me to know about your family?:
27) Is there any history of mental illness in your family?: No
28) Are you currently taking any medication?: No
29) If so, for what reasons and for how long?:
30) Have you ever been hospitalized for psychiatric treatment? yes or no: No
31) If yes, when was it and how long were you in treatment?:
Current Challenges (Place an X next to all that apply):
a. Anger:
b. Finances:
c. Health: X
d. Relationships difficulties:
e. Traumatic experience(s): X
f. Anxiety:
g. Self-esteem and/or self blame (specify which):
h. Work-related problems:
i. Depression:
j. Grief:
k. Parenting difficulties:
l. Psychoses/Delusions/Hallucinations (specify which): X (Images of another Jedi, similar in every way. Hallucinations of old Sith Master)
m. Adjustment to the Imperial lifestyle:
n. body image:
o. Learning disability:
p. Mood instability:
q. Substance use:
r. Alienation/isolation:
s. Low energy/fatigue:
t. Attention deficit and/or hyperactivity disorder (specify which):
Others not covered above (please list):
32) What happened that led you to seek therapy? (please be specific): Regulations. Wanting to know source of Dementia.
33) How long have you lived with this problem and what have you already tried to do about it?: 5 years
34) Have you received psychotherapy and/or psychiatric service before? If so, when and with whom?: No
35) What do you consider to be your greatest strengths (inner qualities, talents, skills, etc.)?: Mentality, stratagems, brute force, light saber skills
36) What do you consider to be your greatest weaknesses?: Lack of humor
37) Is there anything else that you think is important to discuss about your situation?: None
Suicide Risk Assessment:
a. Presence of current suicidal thoughts or impulses? (yes or no): No
b. If yes, do you have a specific suicidal plans? (yes or no):
c. If yes, provide details of your plan:
d. Do you have access to the means to carry out your plan? (yes or no):
e. Any history of previous suicide attempts? (yes or no): No
f. If yes, please provide details:
Risk of Harm to Others:
a. Presence of thoughts or impulses to harm others (yes or no): No
b. If yes, please provide details:
38) Relevant Social/Developmental History:
39) Relevant Medical Conditions/Medications: Right arm amputated in duel. Advanced cybernetic implemented over a year ago. Serious pains when having delusions, as if being struck by a lightsaber. No current medications to speak of.
2) Name: Crystal Starr Light (aka Athena)
3) Age: 34
4) Sex (male, female, asexual, other?): female
5) Species: Human/Felacatian
6) Current Residence: Bastion
8) Military Rate (your job in the Empire): Empress of the Empire
9) Military Rank: former general/current Empress
10) Career aspirations: present: Empress; past: sports
11) Force sensitive? (yes or no): yes
12) Self-reported ability to access The Force (on a scale of 1 [low] to 10 [high]): 7
13) Force affiliation (dark, light, grey, etc.): Dark
14) Religious affiliation? (if applicable?Sith, Jedi, etc.): Sith
15) List any WOSW organizations you may be a member of: Matukai
16) Educational level: college equivalent
17) Relationship Status (single, significant other, married, divorced, etc.): married
18)Occupation of significant other (if applicable): Grand Admiral
19) How long have you been in this relationship? (if applicable): ~6 mo (OOC: depending on SW timeline and what SK says)
20) Including yourself, how many people currently live in your household?: 3
21) If applicable, list all children's names and ages (also indicate if they are stepchildren, adopted, foster): N/A
22) On which planet were you born?: Obroa-Skai
23) On which planet were you raised?: Obroa-Skai, Eriadu
24)Who raised you and how were you related?: Nomi Light, mother; Reed Light, step-father
25) List all siblings, including yourself, in order of birth (also indicate whether bio, step, half, etc.): Grainne (half), Scorpius (half), Johnathan (half), Kejn Kurant (half), Crystal Starr Light/Athena (myself)
26) Is there anything else you would like me to know about your family?: I was raised believing Reed was my father until most recently when Pappy-Wan Kenobi revealed himself to be my biological father (he and my mother had an intimate encounter just before the Battle of Yavin). Reed was upset about this and took out his anger on both me and my mother. Finally, my mother and he separated when I was almost 12. Reed remarried several times, once a woman younger than me. Nomi hopped from man to man, never quite settling down.
27) Is there any history of mental illness in your family?: Unsure (yes for Reed Light, but he's my step-father)
28) Are you currently taking any medication?: No
29) If so, for what reasons and for how long?:
30) Have you ever been hospitalized for psychiatric treatment? yes or no: Yes
31) If yes, when was it and how long were you in treatment?: 3 months
Current Challenges (Place an X next to all that apply):
a. Anger: X
b. Finances:
c. Health:
d. Relationships difficulties: X (Improving relationship with mother)
e. Traumatic experience(s): X
f. Anxiety:
g. Self-esteem and/or self blame (specify which):
h. Work-related problems: X (ruling the Empire)
i. Depression:
j. Grief:
k. Parenting difficulties:
l. Psychoses/Delusions/Hallucinations (specify which):
m. Adjustment to the Imperial lifestyle:
n. body image:
o. Learning disability:
p. Mood instability: X (occasionally I have mood swings)
q. Substance use:
r. Alienation/isolation:
s. Low energy/fatigue:
t. Attention deficit and/or hyperactivity disorder (specify which):
Others not covered above (please list):
32) What happened that led you to seek therapy? (please be specific): Imperial regulations, past issues and wanting to make my new life with Starkiller a success
33) How long have you lived with this problem and what have you already tried to do about it?: I have had issues pertaining to my parents since I was about five years old.
34) Have you received psychotherapy and/or psychiatric service before? If so, when and with whom?: I was captured by Rebels when I was about 26 and stayed in their custody for three weeks, during which time they tortured me. When I was rescued, I was admitted to Imperial Psychiatric care for 3 months until I was declared (barely) fit for duty, thanks to a former associate for the recommendation.
35) What do you consider to be your greatest strengths (inner qualities, talents, skills, etc.)?: passionate, devoted, manipulative, determined, devoted, caring, good looks (well, if you don't mind athletic with little curves), adept at the use of blaster weapons (more recently the verpine s.h.a.t.t.e.r. Rifle), good at persuasion, good leadership qualities, good at most sports
36) What do you consider to be your greatest weaknesses?: obstinate, violent, impulsive, impatient, possessive, jealous, spend-a-holic, can't cook
37) Is there anything else that you think is important to discuss about your situation?: No
Suicide Risk Assessment:
a. Presence of current suicidal thoughts or impulses? (yes or no): No
b. If yes, do you have a specific suicidal plans? (yes or no): N/A
c. If yes, provide details of your plan: N/A
d. Do you have access to the means to carry out your plan? (yes or no): N/A
e. Any history of previous suicide attempts? (yes or no): yes
f. If yes, please provide details: after a particular run-in with Tuskers after I destroyed the Starlight Officer's Club
Risk of Harm to Others:
a. Presence of thoughts or impulses to harm others (yes or no): Yes
b. If yes, please provide details: Wanted to kill Scorpius after his involvement with the death of Grainne?no longer an issue. Wanted to kill Tuskers for hindering my training, for opposing the Empire, for denying the use of a superweapon?it depends on when you ask.
38) Relevant Social/Developmental History: I have been known to lash out violently, such as when I got kicked off a ball team when I hit one of the teammates for insulting me. More recently, I killed my step-father, Reed Light, as one of my trials in Sith training.
39) Relevant Medical Conditions/Medications: Currently pregnant with my first child. Lost my left hand in a lightsaber duel with apprentice, Nahema. Scar on my left shoulder from a duel with Lonefire.
1) Imperial ID # (OOC: just make one up): 051383
2) Name:Jacob Wolf
3) Age:25
4) Sex (male, female, asexual, other?):male
5) Species:
human
6) Current Residence: beach club
8) Military Rate (your job in the Empire):Storm
Trooper Commando Dreizehn, Imperial Storm Trooper Army
9) Military Rank:Sergeant
10) Career aspirations:Imperial knight
11) Force sensitive? (yes or no):yes
12) Self-reported ability to access The Force (on a scale of 1 [low] to 10 [high]): 10
13) Force affiliation (dark, light, grey, etc.): grey
14) Religious affiliation? (if applicable?Sith, Jedi, etc.):none
15) List any WOSW organizations you may be a member of:RGE
16) Educational level:none
17) Relationship Status (single, significant other, married, divorced, etc.): significant other
18)Occupation of significant other (if applicable):not know yet
19) How long have you been in this relationship? (if applicable): 2 weeks
20) Including yourself, how many people currently live in your household?:1
21) If applicable, list all children?s names and ages (also indicate if they are stepchildren, adopted, foster):none
22) On which planet were you born?: unknown
23) On which planet were you raised?:all
24)Who raised you and how were you related?:my father
25) List all siblings, including yourself, in order of birth (also indicate whether bio, step, half, etc.): don't know
26) Is there anything else you would like me to know about your family?:fathers dead, never knew my mother
27) Is there any history of mental illness in your family?:no
28) Are you currently taking any medication?:no
29) If so, for what reasons and for how long?:
30) Have you ever been hospitalized for psychiatric treatment? yes or no:no
31) If yes, when was it and how long were you in treatment?:
Current Challenges (Place an X next to all that apply):
a. Anger: x
b. Finances:
c. Health:
d. Relationships difficulties:
e. Traumatic experience(s):
f. Anxiety:
g. Self-esteem and/or self blame (specify which): x
h. Work-related problems:
i. Depression:
j. Grief:
k. Parenting difficulties:
l. Psychoses/Delusions/Hallucinations (specify which):
m. Adjustment to the Imperial lifestyle:
n. body image:
o. Learning disability:
p. Mood instability:
q. Substance use:
r. Alienation/isolation:
s. Low energy/fatigue:
t. Attention deficit and/or hyperactivity disorder (specify which):
Others not covered above (please list):
32) What happened that led you to seek therapy? (please be specific): to get stonger
33) How long have you lived with this problem and what have you already tried to do about it?:learhing from anyone
34) Have you received psychotherapy and/or psychiatric service before? If so, when and with whom?:no
35) What do you consider to be your greatest strengths (inner qualities, talents, skills, etc.)?:i never give up
36) What do you consider to be your greatest weaknesses?: i care too much
37) Is there anything else that you think is important to discuss about your situation?:no
Suicide Risk Assessment:
a. Presence of current suicidal thoughts or impulses? (yes or no): no
b. If yes, do you have a specific suicidal plans? (yes or no): no
c. If yes, provide details of your plan:
d. Do you have access to the means to carry out your plan? (yes or no):no
e. Any history of previous suicide attempts? (yes or no):
f. If yes, please provide details:
Risk of Harm to Others:
a. Presence of thoughts or impulses to harm others (yes or no):yes
b. If yes, please provide details:
38) Relevant Social/Developmental History:no
39) Relevant Medical Conditions/Medications: no
1) Imperial ID # (OOC: just make one up): #555666
2) Name:Connor Veldman aka Lord Slayer
3) Age:Around 22 unknown
4) Sex (male, female, asexual, other?):
Male
5) Species: Human/Vampire
6) Current Residence: Nekogurl's on earth
8) Military Rate (your job in the Empire):
Imperial Intellagence
9) Military Rank:
?
10) Career aspirations:?
11) Force sensitive? (yes or no):yes
12) Self-reported ability to access The Force (on a scale of 1 [low] to 10 [high]): 10
13) Force affiliation (dark, light, grey, etc.): all above sorta
14) Religious affiliation? (if applicable?Sith, Jedi, etc.):none
15) List any WOSW organizations you may be a member of:
16) Educational level:what
17) Relationship Status (single, significant other, married, divorced, etc.): Dating
18)Occupation of significant other (if applicable):no idea
19) How long have you been in this relationship? (if applicable): dk
20) Including yourself, how many people currently live in your household?:2
21) If applicable, list all children?s names and ages (also indicate if they are stepchildren, adopted, foster):none
22) On which planet were you born?: Earth
23) On which planet were you raised?:none
24)Who raised you and how were you related?:the Clan MacLeod Adopted
25) List all siblings, including yourself, in order of birth (also indicate whether bio, step, half, etc.):?
26) Is there anything else you would like me to know about your family?:True Family dead
27) Is there any history of mental illness in your family?:none
28) Are you currently taking any medication?:no
29) If so, for what reasons and for how long?:
30) Have you ever been hospitalized for psychiatric treatment? yes or no:no
31) If yes, when was it and how long were you in treatment?:
Current Challenges (Place an X next to all that apply):
a. Anger: x
b. Finances:
c. Health:
d. Relationships difficulties:
e. Traumatic experience(s):
f. Anxiety:
g. Self-esteem and/or self blame (specify which):
h. Work-related problems:
i. Depression:
j. Grief:
k. Parenting difficulties:
l. Psychoses/Delusions/Hallucinations (specify which):
m. Adjustment to the Imperial lifestyle:
n. body image:
o. Learning disability:
p. Mood instability:
q. Substance use:
r. Alienation/isolation:
s. Low energy/fatigue:
t. Attention deficit and/or hyperactivity disorder (specify which):
Others not covered above (please list):
32) What happened that led you to seek therapy? (please be specific):
33) How long have you lived with this problem and what have you already tried to do about it?:
34) Have you received psychotherapy and/or psychiatric service before? If so, when and with whom?:No
35) What do you consider to be your greatest strengths (inner qualities, talents, skills, etc.)?: Speed, Strength, power, agility
36) What do you consider to be your greatest weaknesses?: My Anger and My love
37) Is there anything else that you think is important to discuss about your situation?:
Suicide Risk Assessment:
a. Presence of current suicidal thoughts or impulses? (yes or no): No
b. If yes, do you have a specific suicidal plans? (yes or no): No
c. If yes, provide details of your plan:
d. Do you have access to the means to carry out your plan? (yes or no):
e. Any history of previous suicide attempts? (yes or no):No
f. If yes, please provide details:
Risk of Harm to Others:
a. Presence of thoughts or impulses to harm others (yes or no):Yes
b. If yes, please provide details: Easy I'm a Vampire
38) Relevant Social/Developmental History:DK
39) Relevant Medical Conditions/Medications:None
1) Imperial ID # (OOC: just make one up): 0002482-101
2) Name: Garik Maj-Han aka Lord Ire
3) Age: 195
4) Sex (male, female, asexual, other?): Male
5) Species: Human Sith (mostly Human)
6) Current Residence: The Atrocity (Eclipse-class SSD) above Carratos
8) Military Rate (your job in the Empire): Admiral; Imperial Navy.
9) Military Rank: Admiral
10) Career aspirations: Grand Admiral
11) Force sensitive? (yes or no): Yes
12) Self-reported ability to access The Force (on a scale of 1 [low] to 10 [high]): 8
13) Force affiliation (dark, light, grey, etc.): Other
14) Religious affiliation? (if applicable? Sith, Jedi, etc.): Follower of Palawa
15) List any WOSW organizations you may be a member of: RGE, Book club
16) Educational level: Military Combat expert. Extensive force training.
17) Relationship Status (single, significant other, married, divorced, etc.): Single
18)Occupation of significant other (if applicable):
19) How long have you been in this relationship? (if applicable): Too long
20) Including yourself, how many people currently live in your household?: Excluding crew, 1
21) If applicable, list all children?s names and ages (also indicate if they are stepchildren, adopted, foster): N/A
22) On which planet were you born?: Carratos
23) On which planet were you raised?: Carratos then Almas
24)Who raised you and how were you related?: Raised by Parrents and later by a Dark Jedi turned Sith as Master
25) List all siblings, including yourself, in order of birth (also indicate whether bio, step, half, etc.): Only child
26) Is there anything else you would like me to know about your family?: Mother murdered by my Father in a drunken rage.
27) Is there any history of mental illness in your family?: Unknown, posssibly
28) Are you currently taking any medication?: No
29) If so, for what reasons and for how long?: N/A
30) Have you ever been hospitalized for psychiatric treatment? yes or no: No.
31) If yes, when was it and how long were you in treatment?: N/A
Current Challenges (Place an X next to all that apply):
a. Anger: X
b. Finances:
c. Health:
d. Relationships difficulties: X
e. Traumatic experience(s): X
f. Anxiety: X
g. Self-esteem and/or self blame (specify which):
h. Work-related problems:
i. Depression: X
j. Grief: X
k. Parenting difficulties:
l. Psychoses/Delusions/Hallucinations (specify which): X (auditory hallucinations)
m. Adjustment to the Imperial lifestyle:
n. body image:
o. Learning disability:
p. Mood instability: X
q. Substance use: X
r. Alienation/isolation:
s. Low energy/fatigue:
t. Attention deficit and/or hyperactivity disorder (specify which):
Others not covered above (please list):
32) What happened that led you to seek therapy? (please be specific): Too much
33) How long have you lived with this problem and what have you already tried to do about it?: Too long. Genocidal rampages, uncontrolable anger, power drinking, and self injury.
34) Have you received psychotherapy and/or psychiatric service before? If so, when and with whom?: No
35) What do you consider to be your greatest strengths (inner qualities, talents, skills, etc.)?: Military prowness, combat skills, musical inclination
36) What do you consider to be your greatest weaknesses?: The side of me that causes much pain and suffering to all those around me.
37) Is there anything else that you think is important to discuss about your situation?: Is it a good thing that the voices are getting louder?
Suicide Risk Assessment:
a. Presence of current suicidal thoughts or impulses? (yes or no): No, yet some of my past actions have been viewed as suicidal.
b. If yes, do you have a specific suicidal plans? (yes or no): Not at the moment, but who knows what a good battle may bring.
c. If yes, provide details of your plan:
d. Do you have access to the means to carry out your plan? (yes or no):
e. Any history of previous suicide attempts? (yes or no):
f. If yes, please provide details:
Risk of Harm to Others:
a. Presence of thoughts or impulses to harm others (yes or no): Yes
b. If yes, please provide details: Agustus Starwarrior, he has hurt one close to me. not to mention all I touch falls apart.
38) Relevant Social/Developmental History: Exterminated the Ewok spiecies with exception of a certian Ewok Sith Lord. Destroyed the Ewok homeworld and the planet of Munto Codru, devastating the native Codru-Ji people. Conflicting feelings cused a turn from pure anger of Jedi to individual hatred for those who earn it.
39) Relevant Medical Conditions/Medications: None