Online Request Form

Online Request Form

Realeyes is a free eye health and safety program for schools in Ohio and offers education for students aged pre-K through high school. Realeyes programs are available in multiple formats and are now scheduling for the 2025-26 school year. Please complete the required information below and provide all the necessary information so presentations at your school can be scheduled (as a reminder, in-person presentations are based on volunteer availability).
School Information
School Name:*
Primary Contact:*

First NameLast Name
Your position at the school:*
Work Email*
example@example.com
Phone Number

Area CodePhone Number
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County (Butler, Franklin, Summit, etc.):*
County in Ohio*
School District:
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 out our Realeyes Zoom Calendar!

Explore some upcoming date/time options and indicate 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

School Information

Live on Zoom

Pre-Recorded Video

Live in person

Dates

Tell us about your students: