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 David Koon
268 Fairport Village Landing
Fairport, NY 14450
585-223-9130

Back