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
Alec Brook-Krasny
2823 West 12th Street, Suite 1F
Brooklyn, NY 11224
718-266-0267



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