New York State Assembly
Excellence in Reading
Certificate

Information Form


Child’s Name


School


Parent or Guardian Name





Address


Phone


E-mail


Number of Days Completed






Favorite Books


To receive your certificate, please have your parents complete the above form and send it with the attached calendar to:

Assemblymember
Vivian E. Cook
142-15 Rockaway Boulevard
Jamaica, New York 11436
(718) 322-3975


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