Certificate Request Form

The Office of New York State Assembly Member Khaleel M. Anderson is proud to recognize exemplary residents, students, groups, organizations and business owners who are doing critical work to improve the lives of their neighbors in Assembly District 31. The Assembly Member seeks to honor those exemplary individuals with Certificates of Appreciation, Merit, Citations and the highest honor of a Proclamation. Please complete and submit the Acknowledgment Request form below, and a staffer will contact you back within three to five business days.

We STRONGLY discourage the submission of rushed requests. We are asking all entries to consider a seven to ten business days turnaround from the recipient of the request.

All candidates will be reviewed before acknowledgment. The office reserves the right to deny any request(s).