Art Subtest II Submission Form

(to be completed by candidate)

I grant to the Evaluation Systems group of Pearson the right to photographically and digitally record images of
certain of my artistic creations (such artistic creations are referred to herein as the "Art" and the recorded images of
the Art are referred to herein as the "Images").
Furthermore, I do  do not  (check one box) grant to the Commission on Teacher Credentialing (CTC) and to
Evaluation Systems the right to use, without royalty and without the identification of my name, the submitted
Images of my Art and related materials associated with the California Subject Examinations for Teachers®
(CSET®), for research; for the development and implementation of CSET: Art; for scorer training or study
materials; or for other purposes associated with testing programs. If I fail to check either box above, my
signature below and my submission of these Images shall constitute my agreement to grant the foregoing
rights to the CTC and Evaluation Systems.
Regardless of my choice indicated above, by signing and submitting this Art Subtest II Submission Form I hereby
discharge and release the CTC, Evaluation Systems, and all scorers, educators, and/or reviewers involved in the
implementation of CSET: Art from any and all claims of whatever nature arising out of the use and evaluation of
the submitted Images and related materials.

Identify the medium of your artwork for the area of concentration and for each example of breadth. You bear the
burden of proof to demonstrate sufficient breadth across the four different media that you select to photograph.
Your selections should not include crafts (e.g., rubber stamping, journaling, or scrapbooking).

Portfolio 1—Concentration Medium:

Portfolio 2—Breadth 1 Medium:
Breadth 2 Medium:
Breadth 3 Medium:

I certify that the submitted Images depict original artwork created by the person whose name appears
on this form below.

_____________________________________________ _____________________________________
Name of Candidate (print) ID Number

_____________________________________________ _____________________________________
Signature Date

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