Request a Certificate

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
MRETName:

Mailing Address:

Contact Phone:

Email:
Date and location of Certification you attended:
Month:

Year(yyyy):

Location (OR, UT, TX…):

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 and that I have completed the required hours of practicum for the level of certificate I’m requesting. I understand that my Certificate must be renewed annually in December.