TSI REFERRAL FORM:
Note: If applying the Holistic Approach, you must use this form. Email completed form & documentation (Copy of TSI
Scores, High School Transcripts, and Letters of Recommendation) to the appropriate party:
TSI Coordinator: Christi Morgan
chrism@coastalbend.edu
361-664-2981 Ext: 3004
Deadline: The TSI Referral Form and documentation must be submitted to the TSI Coordinator at least two (2)
weeks prior to the first day of class for each semester.
Student’s name:
_________________________
Student’s SSN: _______________________
Student’s ID ___________________________
HS/CBC Site: ___________________
This student is being referred for College Level in:
(check the appropriate area/(s)
Reading __ Writing __ Math___
Student has scored at least the following on TSI test, and are ready for entry level college credit courses:
____Reading 351 or higher ____Essay 5 or Essay 4 + Multiple Choice 363
____ Math 350
Student has made the following scores and needs either Dev Ed course(s) or the holistic approach:
Reading: __ 348-350 (NCBW 0222* or IRW 0312) _347-350 (IRW 0312) _342-346 (IRW 0311) _310-341 (ABE)
Writing: _Essay 4+ MC360-362(NCBW0222* or IRW0312)_357-362 (IRW0312) _350-356(IRW0311) _310-349 (ABE)
Math: ___347-349 (NCBM 0123* or Math 0322) _343-348 (MATH 0322)_336-342 (MATH 0321)_310-335 (ABE)
*The following criteria are grounds for applying the holistic approach.
__Excellent grade point average/class ranking in High School GPA: _____________
__Records of excellence in prior academic coursework or workplace experience (Provide documentation)
__Demonstration of motivation and self-efficacy (documentation)
__ Excellent score in writing and 5 or fewer points away from reading score (reading/writing only)
The following criteria are considered and may qualify or disqualify student from a TSI referral:
__Family life issues (provide documentation)
__English as a second language (provide documentation)
__Goal of a Level I certificate (provide documentation)
__Student is a High School Freshman/sophomore seeking placement in a non-reading or non-writing intensive class.
Note: Students who are in this category may need to take the STAAR exam.
Note: Please ask the Math representative about New Mathways Project options available.
TSI EXEMPT (Minimum Scores; subject to change based on THECB decisions)
____ACT: __23 Composite __ 19 on Writing
__ 19 on Math
_____SAT: _Combined Critical Reading and Math 1070 __500 on critical reading _500 on Math
Go to the following URL to see TSI Exemptions for Dual Enrollment Students:
www.coastalbend.edu/detsiexemptions/
Go to the following URL to see TSI Exemptions for non-Dual Enrollment Students:
www.coastalbend.edu/tsiexemptions/
Go to the following URL to see the CBC Quick Guide to TSI Exemptions/Waivers
http://www.coastalbend.edu/tsiexemptionguide/
__________________________________/__________________/______________________________
Advisor/Counselor’s Printed Name
Date
Advisor/Counselor’s Signature
Below must be signed and dated by TSI Coordinator:
PLACEMENT RECOMMENDATION: _________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________
Signature of TSI Coordinator
Revised – 8/4/15
_________________________
Date