Complete the following:

Name
Employee #
Birthdate
Department
Phone
Email

I would like to request a duplicate W-2 form for the following calendar year:

Enter Year

Reprint Reason:

Misplaced/Destroyed
Never Received
Other (Explain)

W-2 Distribution - Please send the duplicate W-2 form to:

Permanent address of record
Campus address of record
Don't mail it, I will pick it up*
Mail to this campus address: 
Mail to this off campus address: 
Fax to: 

Comments:

*Note:  We will contact you when the duplicate W-2 form is ready for pickup at the Payroll Services window (10920 Wilshire Blvd, Suite 620).  You will need to bring a photo ID with you in order to pick up the W-2 form.

Once you click on the Send Email form button below, a confirmation form will appear.  We suggest that you print it for your records.  If you do not see a confirmation form in your web browser or receive an error message, please call (310) 825-1089 to request a duplicate by phone.