Online Request Form

Online Request Form

Realeyes is a free eye health and safety program for schools in Ohio with programs for PreK through High School classrooms. Scheduling for the 2024-25 school year for Zoom and pre-recorded programs, while In-person programs are based on availability of volunteers in area.
School Name:*
School District:*
Primary Contact:*

First NameLast Name
Your position at the school:*
Work Email*
example@example.com
3 Presentation Formats Available:

Please select your preferred presentation format (select all that apply)
Live on Zoom

Join an optometrist or eye professional, live on Zoom for an interactive presentation with the chance to ask questions!
Zoom Presentations

This is a live presentation with engaging education and Q&A time on Zoom
Is there an Optometrist with whom you want to schedule?
(Optional)
Check our the Realeyes Upcoming Zoom Calendar!

Explore date and time options and indcate your preferences at the bottom of this form in the "Additional Information or notes" section, or complete your sign up through the calendar.
Pre-Recorded Video

Teachers will be given access to a video and be sent activity packets to incorporate into your lessons at any time.
Pre-Recorded Presentations

This is a video version of our programs that a teacher could use at any time without a presenter
Live in person

When a volunteer optometrist or eye professional is available, host them in your classroom for engaging education.
In-Person Presentation

This is the traditional presentation with a local eye doctor (when volunteer is available) coming into your classroom.
Is there an Optometrist with whom you want to schedule?
(Optional)

Online Request Form

Live on Zoom

Pre-Recorded Video

Live in person

School Information

Dates

Tell us about your students: