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
Kevin Cahill
Gov. Clinton Bldg., Suite G-4
1 Albany Avenue
Kingston, New York 12401
(845) 338-9610


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