Submit a request

Request Form:

Your email address

Subject

Description

Your Name (First & Last)

Your Phone # (XXX-XXX-XXXX)

Issue?

If "Other" please specify.

Submitting for self?

Are you able to log into your TEAL account?

User's Name (First & Last)

User's Email Address

TEA ID or Last 4 Digits of Social Security Number

Date of Birth (MM/DD/YYYY)

Alternate names (maiden, nickname, middle) that may have been used

Alternate email addresses that may have been used

Attachments

Add file or drop files here