Fillable Form Intellectual Property Disclosure (Saint Louis University)

Fill Online, Printable, Fillable, Blank Form Intellectual Property Disclosure (Saint Louis University) Form

Use Fill to complete blank online SAINT LOUIS UNIVERSITY pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Form Intellectual Property Disclosure (Saint Louis University)

On average this form takes 58 minutes to complete

The Form Intellectual Property Disclosure (Saint Louis University) form is 18 pages long and contains:

  • 0 signatures
  • 24 check-boxes
  • 220 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Saint Louis University

BROWSE SAINT LOUIS UNIVERSITY FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
CONFIDENTIAL
Saint Louis University | Intellectual Property Disclosure Form | version 2017v02 | Page 1 of 12
SAINT LOUIS UNIVERSITY
INTELLECTUAL PROPERTY DISCLOSURE FORM
Submission Instructions: Please email your completed form to otm@slu.edu
to ensure prompt processing.
I. Researcher Information
Primary Researcher
Full name:
Country of Citizenship:
Home Address:
City, State, Zip:
Telephone:
E-mail Address:
University College and
Department (or
Employer):
Primary affiliation with
University:
Tenured faculty
Non-tenured, tenure-track faculty
Adjunct faculty
Research faculty
Graduate student
Undergraduate student
Staff
Non-university employee (e.g., contractor,
visiting professor, etc.)
Researcher 2
Full name:
Country of Citizenship:
Home Address:
City, State, Zip:
Telephone:
E-mail Address:
University College and
Department (or
Employer):
Primary affiliation with
University:
Tenured faculty
Non-tenured, tenure-track faculty
Adjunct faculty
Research faculty
Graduate student
Undergraduate student
Staff
Non-university employee (e.g., contractor,
visiting professor, etc.)
CONFIDENTIAL
Saint Louis University | Intellectual Property Disclosure Form | version 2017v02 | Page 2 of 12
Full name:
Country of Citizenship:
Home Address:
City, State, Zip:
Telephone:
E-mail Address:
University College and
Department (or
Employer):
Primary affiliation with
University:
Tenured faculty
Non-tenured, tenure-track faculty
Adjunct faculty
Research faculty
Graduate student
Undergraduate student
Staff
Non-university employee (e.g., contractor,
visiting professor, etc.)
Full name:
Country of Citizenship:
Home Address:
City, State, Zip:
Telephone:
E-mail Address:
University College and
Department (or
Employer):
Primary affiliation with
University:
Tenured faculty
Non-tenured, tenure-track faculty
Adjunct faculty
Research faculty
Graduate student
Undergraduate student
Staff
Non-university employee (e.g., contractor,
visiting professor, etc.)
If there are additional researchers, please list them in the “Additional Information” section at the end of this form or
attach additional pages.
CONFIDENTIAL
Saint Louis University | Intellectual Property Disclosure Form | version 2017v02 | Page 3 of 12
II. Intellectual Property Information
Intellectual Property Title:
Indicate Intellectual
Property Type
(Select all
that apply)
Indicate Current Level of Development
Invention
TRL-1: The principles that underlie the technology have been identified.
Software
TRL-2: The application being considered has been outlined and analysis to
support the concept has been provided.
Plant Variety
TRL-3: Laboratory tests have been performed to measure parameters of
interest and compare to analytical predictions for biological functions
critical subsystems.
Ornamental Design
TRL-4: System concepts have been considered and test results are available
from in vitro experiment(s), laboratory-scale breadboard(s), or
prototype(s).
Creative Work
TRL-5: Results available from in vivo experiment(s) or laboratory-tested
breadboard system(s) or prototype(s) that have been integrated with other
supporting elements in a simulated operational environment.
Other
(Explain below):
TRL-6: Results available from phase 1 clinical trial or laboratory testing of a
prototype system that is near the desired configuration in terms of
performance, weight, and volume.
TRL-7: Phase 2 clinical trial plan is prepared or results are available from
testing a prototype system in an operational environment.
TRL-8: Results available from phase 2 clinical trial or testing the system in
its final configuration under the expected range of environmental
conditions in which it will be expected to operate.
TRL-9: The technology has begun phase 3 clinical trial or actually been
applied in its final form and under mission conditions, such as those
encountered in operational test and evaluation (OT&E).
Other (Please explain below):
CONFIDENTIAL
Saint Louis University | Intellectual Property Disclosure Form | version 2017v02 | Page 4 of 12
Non-Confidential Summary of Intellectual Property:
Keywords associated with Intellectual Property:
When and with whom was the Intellectual Property first discussed:
Confidential Description of Intellectual Property (Please provide a full description of the Intellectual Property, including
as much detail as possible (e.g., figures, starting materials, methods of preparation, operative and preferred ranges of
any named parameters, any other foreseeable uses of the Intellectual Property). Please feel free to include attachments
as appropriate (e.g., manuscripts, grant proposals, grant progress reports, etc.) If you include any attachments, please
list them):
CONFIDENTIAL
Saint Louis University | Intellectual Property Disclosure Form | version 2017v02 | Page 5 of 12
Please describe how the problem is currently addressed:
Please describe how your invention or innovation is better than what is currently available:
Please describe what research and development needs to be done to progress the intellectual property through at least
the next development stage (i.e., TRL listed under “Current Level of Development” above).
CONFIDENTIAL
Saint Louis University | Intellectual Property Disclosure Form | version 2017v02 | Page 6 of 12
III. Additional Information for Software (Please complete this section only if the Intellectual Property is software):
Describe plans for any additional testing:
Programming Language Used:
Platform Used (ex: Mac, Windows etc.):
List the hardware and operating system requirements for the software:
Yes/No
If yes, please explain:
Does a manual or any online help
exist?
Yes
No
Can it be used with other software?
Yes
No
Is the software a component or
function of a greater body of code?
Yes
No
IV. Key Dates
Event
Date
Comments (Provide details of any records that
document the date.)
What was the date you conceived the
idea for the Intellectual Property?
What was the date you first conducted
experimental work on the Intellectual
Property?
What was the date you first discussed
the Intellectual Property in public (e.g.,
lecture, presentation, publication, etc.)?
What was the date you considered the
Intellectual Property complete (i.e.,
reduced to practice)?
CONFIDENTIAL
Saint Louis University | Intellectual Property Disclosure Form | version 2017v02 | Page 7 of 12
V. Disclosure Information
Type
Yes/No/
Anticipated
Date (if “yes” or
“anticipated”)
Title (attach copy if available) or Explanation
Submitted manuscripts?
(If yes, has it been
accepted)
Yes
No
Anticipated
Published journal articles?
Yes
No
Anticipated
Presented posters?
Yes
No
Anticipated
Gave lectures?
Yes
No
Anticipated
Submitted grant
proposals?
Yes
No
Anticipated
Posted online (including
conferences and
abstracts)?
Yes
No
Anticipated
Sold, offered for sale, or
used the intellectual
property in public? (If yes,
is there a confidentiality
agreement in place)?
Yes
No
Anticipated
CONFIDENTIAL
Saint Louis University | Intellectual Property Disclosure Form | version 2017v02 | Page 8 of 12
VI. Funding Support
Check this box if no funding was received for developing this Intellectual Property:
Funding Type
Select all
that apply
Acknowledgement
Needed?
Grant/Funding Application
Number
Name of Funding Organization
Federal
State
Contract
Subcontract
Industry
Sponsored
University
Sponsored
Other
CONFIDENTIAL
Saint Louis University | Intellectual Property Disclosure Form | version 2017v02 | Page 9 of 12
Support Type
Yes/No
Comments
Materials obtained under Material
Transfer Agreement (MTA)?
Yes
No
Equipment received?
Yes
No
Other?
Yes
No
Support Type
Yes/No
Comments
Is this software an improvement
based upon existing code?
Yes
No
Does this software contain third-
party code (e.g. subroutine, etc.)?
Yes
No
Did you license anything used in the
development of this software? (If yes,
please list name of code, copyright
holder, license, etc.)
Yes
No
Other?
Yes
No
CONFIDENTIAL
Saint Louis University | Intellectual Property Disclosure Form | version 2017v02 | Page 10 of 12
Type: (Research Project,
Patent, Product, etc.)
Name
Brief Description
CONFIDENTIAL
Saint Louis University | Intellectual Property Disclosure Form | version 2017v02 | Page 11 of 12
(include names, emails, and telephone numbers of specific individuals within each company who would influence the
licensing decision).
authorization?
Primary Researcher
Researcher 2
Researcher 3
Researcher 4
How engaged can you be in the
commercialization process?
I have limited availability to participate in
commercialization activities.
I’m willing to actively assist with
commercialization activities as needed.
I’m interested in actively participating in the
launch and management of a new business
venture to commercialize this intellectual
property.
CONFIDENTIAL
Saint Louis University | Intellectual Property Disclosure Form | version 2017v02 | Page 12 of 12
Property is software.)
Anticipated distribution method:
Yes/No
Comments
Source Code
Yes
No
Object Code
Yes
No
Open Source Licensing and
Publication (Please Specify BSP, GNU
GPL, etc.)
Yes
No
Other (Please explain)
Yes
No
Please email your completed form to otm@slu.edu
to ensure prompt processing.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Form Intellectual Property Disclosure (Saint Louis University)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 21 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document