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?
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
________________________________