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 Andrew Goodell
Fenton Building
2 East Second Street, Suite 320
Jamestown, NY 14701
716-664-7773