New York State Assembly
Excellence in Reading Certificate

Information form


Child’s name


School


Parent/Guardian name


Address 1


Address 2


Phone


Email


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 attached calendar to:

Assemblyman Edward C. Braunstein
213-33 39th Avenue, Suite 238
Bayside, NY 11361
718-357-3588
braunsteine@assembly.state.ny.us

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