INVENTION DISCLOSURE FORM


INVENTION DISCLOSURE FORM


INVENTION DISCLOSURE FORM


INVENTION DISCLOSURE FORM


INVENTION DISCLOSURE FORM

OFFICE OF TECHNOLOGY DEVELOPMENT

UNIVERSITY OF MARYLAND GRADUATE SCHOOL, BALTIMORE


INVENTION DISCLOSURE FORM

Disclosure No. _____________

I. DISCLOSURE OF INVENTION

1. Title of Invention


2. List of Inventors:

Name Title Department Telephone

A. _______________________________________________________________________

B. _______________________________________________________________________

C. _______________________________________________________________________


3. Ownership. In my opinion this invention is:

A. Owned by UMBC in accordance with the University of Maryland System Patent Policy.

B. Was developed by the inventor(s) without use of UMBC time, facilities or materials and belongs to the inventor(s).

C. Is subject to special waiver in accordance with the University of Maryland System Patent Policy.


4. Advisor approval for student submissions (if applicable):

Name/Title: _______________________________________________________

Date: ______________________________________________________ 

5. Description of Invention.

A) In your own words, how would you briefly describe the invention?




B) Is the invention a new process, composition of matter, a device or one or more products? A new use for, or an improvement to, an existing product or process?



NOTE: use additional sheets if necessary. You may also attach a manuscript, research proposal, drawing, or any other material that would assist in understanding the invention.


6. Novel Features. Pick out and expand on the novel and unusual features of the invention. How does it differ from present technology? What problems does it solve? What advantages does it possess?




7. Uses and Applications. What are the possible uses for the invention? What products could be developed? In addition to immediate applications, are there other uses that might be realized in the future?




8. Reduction to Practice.

A) When was the invention first conceived? ________________________

Is this date documented? ____________ Where?


B) Has the invention been tested experimentally? . Please state if you have preliminary results, animal or laboratory models, prototypes, clinical tests, etc. (Simply reference appropriate sections if you have already included this information.)




9. Obstacles. Does the invention have any disadvantages or limitations? How can they be overcome?




II. SUPPORTING INFORMATION

1. Publications. Has the invention or a similar invention in whole or in part been described in a publication? (APublication@ for this purpose includes abstracts of talks, new stories, scientific papers, thesis, etc.) Has the invention been described orally at meetings? Please provide exact details, including dates and copies of any publications.




2. Disclosure.

A) Has this invention been disclosed other than as described in 1.? If so, please specify the date, place and circumstances. If disclosed to specific individuals, please give names and dates.




B) Are you planning any disclosure of the invention within the next six months? Is there an imminent publication, oral presentation, showing or sale of the invention? Please give best estimate of dates and locations.



3. Prior Art.

A) Please list publications and any related patents you may know. Use additional sheets if necessary.




B) Do you know of relevant information presented at a public talk, trade fair, sales catalogue? Has the invention or a similar product been used publicly or has it been offered for sale?




4. Sponsorship. Who sponsored or paid for the work that led to the invention or part thereof? (Federal or State agency, industry, DRIF, UMAB/UMBC, etc.)

SPONSOR CONTRACT OR GRANT NO.



5. Marketing Information.

A) Has there been any commercial interest in this invention? Please name companies and specific persons, if known.




B) What firms do you think may be interested in this invention? Why?




C) Are there any products currently in the market that compete with your invention? What company(ies) makes them?




D) Can you help us estimate the potential size of the market? For example, if the invention is a new therapeutic agent, can you give an estimate of the number of people afflicted in the U.S. and abroad?




E) Would your invention be primarily used in countries other than the U.S.? (e.g. the invention is a vaccine for a tropical disease, etc.)




F) Do you know of other research groups that may be working on similar inventions? Who are they and where are they located?




6. Inventor(s) Information and Signature.

Name: _____________________________ Telephone: _________________________

Address: ________________________________________________________________

Signature:_____________________________ Date: _____________

Name: _____________________________ Telephone: _________________________

Address: ________________________________________________________________

Signature:_____________________________ Date: _____________

Name: _____________________________ Telephone: _________________________

Address: ________________________________________________________________

Signature:_____________________________ Date: _____________

Witness:

Signature _________________________ Date __________________

Typed Name ________________________________



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