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 Ellen C. Jaffee
Room 530, LOB
Albany, NY 12248
518-455-5118

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