New York State Assembly
Excellence in Reading Certificate

Information form


Child’s name:


Parent/Guardian name:


Address1:


Address2:


Phone/E-mail:


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 calendar to:

Assemblyman
William Magnarelli

333 East Washington Street, Room 840
Syracuse, NY 13202
315-428-9651
magnarw@assembly.state.ny.us


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