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:

Assemblyman
Brian M. Kolb
607 West Washington Street, Suite 2
Geneva, NY 14456
315-781-2030



Back