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California Military Institute
755 North A Street, Perris, CA
92570
phone: 951-443-2731 fax: 951-943-
Home of the Rough Riders
COMMUNITY SERVICE HOURS
(PLEASE PRINT)
Cadet Name
Date:
Grade
Start Time
End Time
Total Hours
Uniform: Y
N
End Time
Total Hours
Uniform: Y
N
End Time
Total Hours
Uniform: Y
N
Name of Organization:
Work Performed:
Student Signature:
Supervisor Signature:
Date:
Start Time
Name of Organization:
Work Performed:
Student Signature:
Supervisor Signature:
Date:
Start Time
Name of Organization:
Work Performed:
Student Signature:
Supervisor Signature:
I understand that I shall be honest in all matters regarding my community service.
I verify that the information on this sheet is correct.
Cadet Signature:
CMI JROTC Teacher Signature:
TO BE COMPLETED BY 1 Period Teacher:
Hours Credited
Total Hours Received
California Military Institute
755 North A Street, Perris, CA
92570
phone: 951-443-2731 fax: 951-943-
Home of the Rough Riders
COMMUNITY SERVI