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OFFICE OF TECHNOLOGY COMMERCIALIZATION Title of Invention Invention Disclosure Form Date Name Department School CONFIDENTIAL

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Page 1: OFFICE OF TECHNOLOGY COMMERCIALIZATION Title of Invention Invention Disclosure Form Date Name Department School CONFIDENTIAL

OFFICE OFTECHNOLOGY COMMERCIALIZATION

Title of Invention

Invention Disclosure Form

Date

NameDepartmentSchool

CONFIDENTIAL

Page 2: OFFICE OF TECHNOLOGY COMMERCIALIZATION Title of Invention Invention Disclosure Form Date Name Department School CONFIDENTIAL

OFFICE OFTECHNOLOGY COMMERCIALIZATION

Information in this report is supplied by the investigators pursuant to obligations of researchers specified in Rowan University Intellectual Property Policy for University Research.

Timely disclosure of Federally funded research is required by Federal Law under the Bayh Dole Act, 37 CFR 401.14(c)

If you have questions completing this document, please contact the Director of Intellectual Property, Mina Zion at x5097 or email at [email protected]. Please distribute copies to all individuals who worked on this invention as identified in the inventor distribution section of this document. Please provide publications, technical data and other supporting documents in separate attachments upon delivering this document.

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Page 3: OFFICE OF TECHNOLOGY COMMERCIALIZATION Title of Invention Invention Disclosure Form Date Name Department School CONFIDENTIAL

OFFICE OFTECHNOLOGY COMMERCIALIZATION

Invention Abstract.

• Functional purpose of invention:

• Industry and companies most likely to benefit from invention:

• Current State of Art – How is technology currently being used:

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Page 4: OFFICE OF TECHNOLOGY COMMERCIALIZATION Title of Invention Invention Disclosure Form Date Name Department School CONFIDENTIAL

OFFICE OFTECHNOLOGY COMMERCIALIZATION

Prior Art.

• How is invention different from existing technologies:

• How is invention superior to existing technologies:

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Page 5: OFFICE OF TECHNOLOGY COMMERCIALIZATION Title of Invention Invention Disclosure Form Date Name Department School CONFIDENTIAL

OFFICE OFTECHNOLOGY COMMERCIALIZATION

Conception of invention.

• Date of conception:

• Physical location of conception:

• Parties involved in conceiving, developing, refining and/or proving invention:

First/Middle/Last, Title, Department, Company/University, Citizenship, Phone

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Page 6: OFFICE OF TECHNOLOGY COMMERCIALIZATION Title of Invention Invention Disclosure Form Date Name Department School CONFIDENTIAL

OFFICE OFTECHNOLOGY COMMERCIALIZATION

Disclosure.

• Names all parties who have proprietary, confidential knowledge of invention:

• Name all parties who you expect will have such knowledge:

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Page 7: OFFICE OF TECHNOLOGY COMMERCIALIZATION Title of Invention Invention Disclosure Form Date Name Department School CONFIDENTIAL

OFFICE OFTECHNOLOGY COMMERCIALIZATION

Project Funding.

• Names all sources of Federal Funding, include Grant/Contract/Agreement Number:

• Name all sources of Non-Federal Funding, include Grant/Contract/Agreement Number:

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Page 8: OFFICE OF TECHNOLOGY COMMERCIALIZATION Title of Invention Invention Disclosure Form Date Name Department School CONFIDENTIAL

OFFICE OFTECHNOLOGY COMMERCIALIZATION

Other agreements relevant to this invention file.

• Identify all agreement types and parties relating to this invention:

Agreement Type Other Parties to Agreement and Description

Material Transfer Agreement

Confidentiality Agreement

Collaboration Agreement

Research Agreement

Consortia Agreement

Consulting Agreement

Other

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Page 9: OFFICE OF TECHNOLOGY COMMERCIALIZATION Title of Invention Invention Disclosure Form Date Name Department School CONFIDENTIAL

OFFICE OFTECHNOLOGY COMMERCIALIZATION

Submit to the Office of Technology [email protected]

856-256-5097

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