TRANSFER DISPUTE RESOLUTION FORM

TEXAS HIGHER EDUCATION COORDINATING BOARD

This form is to be completed in accordance with the rules and guidelines of the Texas Higher Education Coordinating Board in regard to transfer disputes (Chapter 5, Subchapter A, Section 5.4, Paragraph 6).  Definitions, instructions, and examples of "Problems vs. Dispute"are contained in the instructions to  Courses: Transfer Curricula and Resolution of Transfer for Lower-Division Courses:

This form shall be initiated at the institution which disputed credit was earned (the sending institution).  With regard to time frames, all references to "days" are to calendar days unless otherwise noted.

Sending Institution:

        Institution: __________________________________________________________________________________

        Address: ___________________________________________________________________________________

        Chief Academic Officer (CAO): ___________________________________________________________________

        Telephone #: _______________________________________ Fax #: ____________________________________

        Date of Denial Notification: ______________________________________________________________________

        Course(s) Denied: _____________________________________________________________________________

        Challenge of the Denial: (use additional pages if needed) ___________________________________________________________

        __________________________________________________________________________________________________________

        __________________________________________________________________________________________________________

        Student whose Credit is Denied:

                    Name: _________________________________________________________________________________

                    I.D. #: ____________________________________ Telephone #: __________________________________

                    Address: ______________________________________________________________________________

                    Major: ____________________________ Level/Classification: ____________________________________

Receiving Institution:

        Institution: __________________________________________________________________________________

        Address: ___________________________________________________________________________________

        Chief Academic Officer (CAO): ___________________________________________________________________

        Telephone #: _______________________________________ Fax #: ____________________________________

        CAO Signature: ______________________________________________________________________________

        Sending Institution: ___________________________________________________________________________

        Date: ______________________________________________________________________________________

                                                                                                                                                                                                   CB-TDR 7/91

Dispute Not Resolved:

        Course(s) Denied:____________________________________________________________________________

        __________________________________________________________________________________________

        Reason: ____________________________________________________________________________________

        __________________________________________________________________________________________

        CAO Signature: ______________________________________________________________________________

        Denying Credit: ______________________________________________________________________________

        Date: ______________________________________________________________________________________

Dispute Resolved:

        Resolution: _________________________________________________________________________________

        __________________________________________________________________________________________

        CAO Signatures: ____________________________________________________________________________

        Institution Denied: ___________________________________________________________________________

        Institution Denying: __________________________________________________________________________

        Date: _____________________________________________________________________________________

Disputes Not Resolved:

        Commissioner's Resolution: _____________________________________________________________________

        __________________________________________________________________________________________

        Commissioner's Signature: ___________________________________________ Date: ______________________

Copies:

        Student

        CAO Institution whose credit was denied

        CAO Institution denying credit

        Commissioner of Higher Education

Please submit to:

        Commissioner of Higher Education

        Texas Higher Education Coordinating Board

        P.O. Box 12788

        Austin, Texas 78711

                                                                                                                                                                                                    CB-TDR 7/91