THEA E-mail Communication

If you wish to request additional information in writing, complete the e-mail communication form below. Provide as much information as possible to help us respond accurately to your message (including all required fields designated with an asterisk).

Please allow 23 business days for a response to your e-mail information request.

NOTE: E-mail responses will be sent from Please make sure that your e-mail service will accept messages from this address.

*First name: 
Middle initial: 
*Last name: 
Street 1: 
Street 2: 
Zip/postal code: 
THEA ID number:  ( X-XXX-XXX-X )
Date of birth:  ( MM/DD/YY )
*E-mail address: 
*Confirm e-mail address: 
Daytime telephone number:  ( XXX-XXX-XXXX )
Evening telephone number:  ( XXX-XXX-XXXX )