Student Partner Lens Program
Student Name
*
Contact Phone Number
*
School
*
Contact Email
*
School Acct #
*
AR Treatment
*
EX3+
Recharge
Lens/Design or Style
*
Select a Style
Array 2
Array Wrap VL PAL
iD Lifestyle 3 Indoor
iD Lifestyle 3 Outdoor
iD Lifestyle 3 Urban
iD Screen
iD Space
iD Zoom
Single Vision iD
Single Vision iQ
Sync III 13
Sync III 5
Sync III 9
Specify Base Curve
*
6
7
8
Choose Material/Treatment
*
Select a Material
Coppertone Phoenix
Coppertone Polycarbonate
High Index 1.67
Phoenix
Polarized 1.67
Polarized Phoenix
Polarized Polycarbonate
Polycarbonate
Sensity 1.67
Sensity Dark 1.67
Sensity Dark Phoenix
Sensity Dark Polycarbonate
Sensity Phoenix
Sensity Polycarbonate
Sensity Shine 1.67
Sensity Shine Phoenix
Sensity Shine Polycarbonate
Choose Color
Select a Color
Brown
Clear
Gray
Green
Green
Prescription
All fields are required. If no value, please type "N/A"
Prescription Right Eye
*
Sphere
Cylinder
Axis
Distance PD
Add
Seg Height/OC
Prism/Direction
Near PD
Prescription Left Eye
*
Sphere
Cylinder
Axis
Distance PD
Add
Seg Height/OC
Prism/Direction
Near PD
Note: Monocular PD required for digital designs
Special Instructions
Position of Wear Measurements (Digital)
Pantoscopic Tilt
Wrap Angle
Vertex Distance
Frame Info
Frame Type:
*
Plastic
Metal
Groove
Drill/Notch
Frame Details
*
A
B
ED
DBL
Eye Size
Circum
Brand/Model #
Finishing
Finishing Options
Metal Edging
Grooved Rimless
Full Metal Grooved
Wrapped Frame
4 Hole Rimless Drill
Shelving
Rolled Edges
Polished Edges
Make sure you submit your frames with the Hoya frame tag provided by your school administrator.
Privacy Policy
*
By submitting this form you agree to accept the Hoya Vision Care
privacy policy
and the terms of use.
