TSI REFERRAL FORM:
Note: If applying the Holistic Approach, you must use this form. Email completed form & documentation (Copy of TSI
Scores, Transcripts, Letters of Recommendation, etc….) to the appropriate party:
TSI Coordinator : Kathleen Cuyler
kcuyler@coastalbend.edu
361-354-2428
Student’s name:
_______________ Student’s ID ________________HS/CBC Site: _____________
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 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)
___PLAN: __ 23 Composite __19 or higher Writing __ 19 or higher Math
__ PSAT: __Combined Score 107 __minimum of 50 on Critical Reading __minimum of 50 on Mathematics
____ACT: __23 Composite __ 19 on Writing
__ 19 on Math
_____SAT: _Combined Critical Reading and Math 1070 __500 on critical reading _500 on Math
_____TAKS: _2200 on Math __2200 on English Language Arts
_____STAAR
__ 3 on Writing
___Level 2 (4000) on English II EOC __Level 2 (4000) on Algebra I EOC and passed Algebra II
____TAAS (until Fall 2016) __1770 writing test ___TLI of 86 on Math ___TLI of 89 on Reading
Advisor/Counselor’s name (PRINT), date, and signature: _______________________________________
Below must be signed and dated by TSI Coordinator:
PLACEMENT RECOMMENDATION: _______________________________________________
Revised – 5/18/15