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:

Assemblywoman Michele R. Titus
19-31 Mott Avenue, Room 301
Far Rockaway, NY 11691
718-327-1845


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