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
Bill Magnarelli
333 East Washington Street, Room 840
Syracuse, NY 13202
315-428-9651

Back