Date of Birth
TSU Student ID
I give my permission for Texas Southern University to retrieve TSI Assessment scores from the institution listed on this form and for those TSI Assessment scores to be applied to my registration records at Texas Southern University. I hereby knowingly, freely, and voluntarily waive any right or cause of action arising as a result of the transmission of my test scores from which any liability may or could accrue to Texas Southern University, the State of Texas, and any other governmental body, institution of higher education, or corporate entity which was associated with the transmission of the requested information. I understand it may take at least 48 to 72 hours for my test scores to be retrieved from the other institution.
Testing Site Information
College/Institution/Testing Site Name
Date of Testing Day
Student Name used the day of testing
Student ID used at Testing Site
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TSU Contact Information
Dr. Shakila Farmer
Testing Center Director