TSI Assessment Score Release/Request Form

TSI Assessment Score Release/Request Form

Created April 2021
This request will be mailed to Diane Milner at dmilner@tvcc.edu.

This authorizes the retrieval of TSI assessment Test scores taken at another Texas public school, college, or university other than Trinity Valley Community College.
- DO NOT use abbreviations (There are many schools with AISD, MISD, PISD, etc.)
- All information MUST be complete.
- Partial or inaccurate forms cannot be processed.
Please allow up to 48 hours for this service.
Name*

First NameMiddle NameLast Name
Maiden Name (If applicable)
Student's Date of Birth*

MonthDayYear
Student's Contact Phone*
Student's Contact Email*
Student's TVCC Cardinal ID
Only if you have one.
TVCC E-Mail
'TVCC E-Mail' is read only
Student's Identification

Student's ID number or TVINLast 4 digits of Social Security Number
Student ID Number*
Colleague ID or TVIN
Last 4 Digits of Soc. Security Number*
Government Issued Photo ID*

Cancelof
Name of High School / College / University where you tested*
Town or School District where tested (Complete Name)*
Nearby College to Testing Location*
Required*

I AUTHORIZE the release of my TSI Assessment scores taken at the above High School or College/University to Trinity Valley Community College through a state-wide database.
Signature*

Clear
Signature MUST match ID
Should be Empty: