Alvin Community College
TSI Assessment Score Retrieval Form
First Name: Last Name: DOB:
ACC Student ID Number:
Name of educational institution where TSI was previously taken:
___________________________________________________________________________________________
I give ACC permission to retrieve/process my test scores taken at another Texas institution. My electronic
signature grants ACC permission to retrieve and process my test scores that were taken at another Texas
institution.
E-signature: Date:
Email completed form to: Assessment@alvincollege.edu.
This area for ACC use only.
Date: _______________ Writing SEN _______ ABE: ______ Essay ______ Code: ________
Date: _______________ Reading _________ ABE: ______ Entered by: _____________________________
Date: _______________ Math: ___________ ABE: ______ DEVC Reviewed by: ______________________
Rev. 4/2020 CM
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signature
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