New York State Assembly
Excellence in Reading Certificate

Information form


Child’s name:


Parent/Guardian name:


Address1:


Address2:


Phone/E-mail:


Number of days completed:


Favorite book read this summer:


Number of years participated in the Summer Reading Challenge:

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

Assemblyman
Jeffrion L. Aubry

District Office:
98-09 Northern Boulevard
Corona, NY 11368
718-457-3615
Fax: 718-457-3640
aubryj@assembly.state.ny.us


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