W-2 Reissue Form

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University Payroll W-2 Reissue Request Form

Part I: Employee Information

Employment

Employment Endowed Contract

Affiliation

Affiliation Faculty Staff Student Former Employee

W-2 Reissue Request Form

A short description to explain the nature of a ticket.

Employee ID / NetID

The employee ID number or NetID of the person for whom this request is being submitted.

Last Four Digits of SSN

Date of Birth [MM/DD/YYYY] (mm/dd/yyyy)

Current Street Address

City

State

Zip Code

Daytime Phone

Will be used for verification purposes

E-mail Address

Part II: W-2 Information

Year To Be Reissued

Request to Pick Up in Person

Request to Pick Up in Person Yes No

Reason for Reissue Request:

Reason for Reissue Request: Lost Destroyed Never Received Sent to a Different Address (see below) Other (specify below)

If sent to a Different Address, Where?

If "Other", Please Specify

Part III: Authorization

By selecting the "yes" button, I attest that I am the employee named within this request and authorize the reissue of my W-2 as outlined within this form.

By selecting the "yes" button, I attest that I am the employee named within this request and authorize the reissue of my W-2 as outlined within this form. Yes

Other Fields

Your name

Your first name

Your last name

Your email address

Verification Code