Free community service form 26Free community service form 26
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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