Requestor Information
Student Name
*
First Name
Last Name
Date of Birth
*
Date Format: MM slash DD slash YYYY
TSU Student ID
*
Email
*
Phone Number
*
Consent Agreement
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.
*
Yes
Testing Site Information
College/Institution/Testing Site Name
*
ISD Name
Date of Testing Day
*
Student Name used the day of testing
*
Student ID used at Testing Site
*
Upload files - test scores, a copy of ID and etc.
If you would like to upload a file(s), please click the Browse Button above(Maxsize : 8Mbyte).
Drop files here or
Accepted file types: jpg, pdf, png, gif.
Signature
*
Press and hold the left mouse button in the box and draw your signature.
If you want to delete it and try again simply press "Clear" icon in the bottom right corner.
Date
*
Date Format: MM slash DD slash YYYY
Please type the words or numbers in the box. If you want to delete it and try again simply press "Clear" icon in the top right.
TSU Contact Information
NAME
TITLE
PHONE
E-MAIL
Stephanie Neveu
TSI Coordinator
713-313-6886
stephanie.neveu@tsu.edu
University Testing Center
-
713-313-6838
testing@tsu.edu
