Certificate Request Form

Please use the form below to certify completion of your RET or MRET requirements. All fields that apply to you are required.

Certificate Requested: RET MRET
Name:
Address:
Phone:
Email:

Date and location of Certification you attended:
Month: Year: Location:

I have completed the required 100 hours of RET that qualifies me to receive my RET certificate from the Rapid Eye Institute.

I have completed the required 100 additional hours of RET that qualifies me to receive my MRET certificate from the Rapid Eye Institute.

By submitting this form to the Rapid Eye Institute, I certify that the information above is true and correct to the best of my knowledge. I understand that my Certificate must be renewed annually in December.