Fillable Intellectual-property

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Intellectual-property

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OSPR Internal Use Only
Invention Disclosure #:
Submit via TU's File Delivery Service to ndufau@towson.edu.
Inquiries can be directed to:
Nancy Dufau, Assistant Vice President, Office of Sponsored Programs &
Research, ndufau@towson.edu, x5822
Ashley Hoover, Associate General Counsel, Office of the General Counsel,
ahoover@towson.edu, x4003
1. Title of Invention
2. Br
ief Description of Invention
3. Detailed Description of Invention
A
ttach a complete description of the technology. The description must describe how the invention will be made and
used, and
should include specific examples, drawings, diagrams, etc. The description should clearly separate the
technology from the current
stage of the art.
It
may be by reference to a
separate document (copy of a report, preprint,
grant application, etc.) attached hereto. If
so,
identify the source document. If the technology is software, include a
copy of the source code with this form and also send it securely to the Assistant Vice President for Sponsored
Programs and Research.
4. Inventor Data (attach additional inventors as needed)
a. Inventor #1/Primary Contact Person Inventor Royalty Share (TU Inventors):
Full Name: Department/Center:
Official Position Title: Direct Phone:
Towson ID#: E-Mail:
Work/Campus Address:
Check Box if you are a student: Graduate Undergraduate
Appointment(s) at the time the invention was developed:
- Primary appointment:
- Other appointments (internal/external). Use additional sheets as necessary.
b. Inventor #2
Full Name:
Official Position Title:
Inventor Royalty Share (TU Inventors):
Department/Center:
Direct Phone:
Towson ID#: E-Mail:
Work/Campus Address:
Check Box if you are a student: Graduate Undergraduate
Appointment(s) at the time the invention was developed:
- Primary appointments
- Other appointments
(internal/external). Use additional sheets as necessary.
TOWSON
UNIVERSI.
  
5. Sponsorship
Funding Source:
Name of Sponsor/Grantor TU Account #
6. Collaborating Institution/Company or Other Research Support
Collaborating Institution/Company Name Collaborating Investigator's Name
Did you use materials, equipment, or software from another company/institution?
Reference #:
Date:
Date:
Date:
Date: Where:
7. Date of Invention
Date Conceived:
Location of L
ab Records:
8. Publication
a) Submitted to a Journal:
b) Published:
c) Poster Presentation:
d) Oral Disclosure:
e) Other Disclosure:
Date:
Journal Name:
Journal Name:
Published Abstract:
When:
Describe:
Grant/Contract #
Federal State
C
orporate TU Other
Yes No
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
a. Was this invention made under any other agreement(s) (e.g. collaboration, material transfer, nondisclosure,
or
other non-funded agreement?
Yes No
Describe:
c. Inventor #3 Inventor Royalty Share (TU Inventors):
Full Name: Department/Center:
Official Position Title: Direct Phone:
Towson ID#:
E-Mail:
Work/Campus Address:
Check box if you are a student: Graduate Undergraduate
Appointment(s) at the time the invention was developed
- Primary appointment:
- Other appointments (internal/external). Use additional sheets as necessary.
9. Technological Significance (check one)
11. Commercial Potential
a. List all products, processes and/or services you envision resulting from this invention and whether they can be
developed in the near term (less than two years) or long term.
b. Software inventions: If this is a modification or improvement to an existing work or incorporates elements that
are not original to the creator(s), please identify that work and its creator(s).
c. Describe alternate technology or products, processes and/or services currently on the market that accomplish
the purpose of this invention. How is your invention an improvement?
d. List any companies you believe may be interested in this technology. Provide contact(s), address(es), and
phone number(s) for each, if available.
12. Inventor's Signature(s)
In order for this Intellectual Property Disclosure Form to be complete, and to be processed by OSPR, it must be
signed and dated by all inventors.
I/we, the Inventors, hereby certify that the information set forth in this Intellectual Property Disclosure Form is
true and complete to the best of my/our knowledge.
I/we, the Inventors who are subject to University System of Maryland, Board of Regents Policy and are not
under an obligation to assi
gn intellectual property rights to another party, hereby affirm that in consideration for
TU's evaluation of commercial potential and a share of income which I/we may receive upon commercialization
of my/our invention, I/we on the date of my/our signature as indicated below do hereby assign and transfer my/
our entire right, title and interest in and to the invention described herein unto TU, its successors, legal
representatives and assigns.
Inventor Signature Print Name Date
1.
2.
3.
4.
Modification to existing technology
10. Technology Stage (check one)
Substantial advancement in the art Major breakthrough
Concept Design Prototype Modification
Production
Model
Ready to
license final
product
Used in
current
work
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Intellectual-property

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Completed 14 February 2020

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