2024-2025 Academic Year

*Last Name(Required.)

*First Name(Required.)

*College or Institution
Select the institution you attended during the current Opt-Out Data Collection Term listed above. The list only includes institutions required to submit data in PIMS during this term.(Required.)

Bucks County Community CollegeButler County Community CollegeCarlow UniversityCheyney UniversityCommonwealth University - BloomsburgCommonwealth University - Lock HavenCommonwealth University - MansfieldCommunity College of Allegheny CountyCommunity College of Beaver CountyCommunity College of PhiladelphiaDelaware County Community CollegeEast Stroudsburg UniversityHarrisburg Area Community College (HACC)Indiana UniversityKutztown UniversityLackawanna CollegeLehigh Carbon County Community CollegeLincoln UniversityLuzerne County Community CollegeMillersville UniversityMontgomery County Community CollegeNorthampton Community CollegeNorthern Pennsylvania Rural Regional CollegePenn State UniversityPennsylvania Highlands Community CollegePennsylvania Western University - CaliforniaPennsylvania Western University - ClarionPennsylvania Western University - EdinboroReading Area Community CollegeShippensburg UniversitySlippery Rock UniversityTemple UniversityThaddeus Stevens School of TechnologyUniversity of PittsburghWest Chester UniversityWestmoreland County Community College

*Student Identification Number
Enter your student identification number at the institution selected. DO NOT enter your social security number (SSN).(Required.)

*Data Collection Opt-Out Acknowledgement
By submitting this form I am requesting the postsecondary institution that I have selected to exclude my information from its PIMS data submission for the term indicated on this form. I am aware that the PDE will use the information I provide to notify the postsecondary institution of my decision to opt-out of this data collection.(Required.)

Acknowledge