Fillable Patent-Invention Disclosure Form 2009 1

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Patent-Invention Disclosure Form 2009 1

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The Patent-Invention Disclosure Form 2009 1 form is 3 pages long and contains:

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  • 4 check-boxes
  • 55 other fields

Country of origin: US
File type: PDF

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CALIFORNIA STATE UNIVERSITY, FRESNO
AND CALIFORNIA STATE UNIVERSITY, FRESNO FOUNDATION
PATENT/INVENTION DISCLOSURE FORM
1. TITLE OF INVENTION
2. DESCRIPTION OF INVENTION: In describing the technology, please provide when possible information
covering the following points:
(a) the general purpose;
(b) a technical description;
(c) the advantages and improvements over the existing methods, devices or materials; and,
(d) the economic potential or commercial applications for the technology.
Please Use Text Box for Describing Technology
CONFIDENTIAL Page 1 of 4
Print Form
Position:
Work Fax:
H
ome Phone:
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Position:
Work Fax:
H
ome Phone:
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3. INVENTOR(S)
(If more than 3 inventors please download Additional Patent/Invention Disclosure Form)
4. SPONSORSHIP
Was this invention developed with the use of any research, grant or contract funds? YES NO
5. DATE OF INVENTION & PUBLIC DISCLOSURE
DATE(S)
(Please verify that your dates are accurate as prior
disclosure may affect the possibility of securing
intellectual property rights.)
REFERENCES / COMMENTS
(Please include the names of any periodical,
journal, or scientific publication(s). Also include
any clarifying comments)
A. Date invention was conceived.
B. First publication date.
(Include publication(s) disclosing the invention,
sufficient enough to enable one skilled in the art to
understand, make or use the invention)
C. First public oral disclosure or
use of invention.
(Include oral disclosures of invention or public use
by self or another, sufficient enough to enable one
skilled in the art to understand, make or use it.)
D. Sale of invention.
(Include any sales or offers to sell the invention)
E. Plans to publish or disclose
invention.
(If invention is unpublished or undisclosed,
include the anticipated publication or oral
disclosure date and any submissions made for
potential publication.)
If yes, please explain: (Include contract or grant numbers; also, if applicable, include the principal investigator of project.)
Cit
y
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tate:
H
ome Address:
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mail:
Work Phone:
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t:
Name:
THIRD INVENTOR
Cit
y
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tate:
H
ome Address:
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mail:
Work Phone:
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t:
Name:
SECOND INVENTOR
Zi
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:Cit
y
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S
tate:
H
ome Address:
H
ome Phone:
E
mail:
Work Fax:
Work Phone:
Position:
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t:
Name:
FIRST INVENTOR
CONFIDENTIAL Page 2 of 4
6. REDUCTION TO PRACTICE
Has the invention been reduced to practice? YES NO
If yes, please provide the date of first reduction to practice:
7. BY SIGNING THIS TECHNOLOGY DISCLOSURE, EMPLOYEES OF CALIFORNIA STATE
UNIVERSITY, FRESNO OR CALIFORNIA STATE UNIVERSITY, FRESNO FOUNDATION
UNDERSTAND THEY ARE SUBJECT TO THE UNIVERSITY’S POLICIES, INCLUDING, BUT NOT
THE LEAST OF THE UNIVERSITY’S INTELLECTUAL PROPERTY POLICY, 540
AND CONFLICT
OF INTEREST POLICIES.
CALIFORNIA STATE UNIVERSITY, FRESNO, CALIFORNIA STATE UNIVERSITY, FRESNO
FOUNDATION, THEIR EMPLOYEES, TRUSTEES, OFFICERS, STUDENTS, INTERNS AND
CONSULTANTS EXTEND NO WARRANTIES AND ACCEPT NO LIABILITY BY PROVIDING
INTELLECTUAL PROPERTY SERVICES TO INVENTORS. THE UNIVERSITY AND THE
FOUNDATION PRESERVES THEIR CONTRACTUAL SOVEREIGN IMMUNITY.
8. DECLARATION
I hereby declare that all statements made herein of my own knowledge are true and that all statements made on
information and belief are believed to be true.
S
i
g
nature:
ate:
Inventor’s Name:
S
i
g
nature:
ate:
Inventor’s Name:
nature:
S
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ate:
Inventor’s Name:
9. WITNESS
THIS INVENTION HAS BEEN DISCLOSED AND UNDERSTOOD BY:
Signature of Non-Inventor Witness _____________________________________ Date _________________
Name and Title of Witness _____________________________________________________________________
Submit To: Office of Research and Sponsored Programs, 4910 North Chestnut Avenue M/S OF123, Fresno, CA 93726-1852.
CONFIDENTIAL Page 3 of 4
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CALIFORNIA STATE UNIVERSITY, FRESNO
AND CALIFORNIA STATE UNIVERSITY, FRESNO FOUNDATION
INSTRUCTIONS FOR THE PATENT/ INVENTION DISCLOSURE FORM
THE FOLLOWING INSTRUCTIONS APPLY TO THE CORRESPONDING NUMBERED SECTIONS
ON THE PATENT/INVENTIONS DISCLOSURE FORM
1. Enter a brief descriptive title to aid in identifying the technology.
2. In describing the technology, please provide (when possible) information covering the following
points:
a. the general purpose;
b. a technical description;
c. the advantages and improvements over the existing methods, devices or materials; and,
d. the economic potential or commercial applications for the technology.
3. Include the names of any co-inventors. Co-inventors include any individual who has conceived or
contributed to an essential element of the invention, either independently or jointly with others,
during the evolution of the technology or reduction to practice.
4. Give the applicable research, contract or grant number(s) and the principal investigator(s) on the
project if the invention was made in connection with any sponsored research.
5. In the United States, a patent application must be filed no later than one year after the public has
access to a printed publication disclosing the invention in detail. In other countries, filing must take
place before either oral or printed publication is made available to the public; however, where there
has been a U.S. filing before any oral or printed publication, generally a one year grace period is
granted for foreign filing. Complete all parts of section 5 in view of the following:
a. Conception involves the formulation, in the mind of the inventor, of the complete means for
solving a problem.
b. The term “first publication” means the first time any member of the general public or anyone
outside the California State University, Fresno community (including faculty, staff, students),
without restriction of confidentiality, would have been able to gain access to your written or
printed enabling description of the invention.
c. The term “first public oral disclosure” is similar to the description for “first publication”, but
only as to oral presentation(s) to the general public or professional groups, peers, and others
outside the California State University, Fresno community.
d. The term “sale of invention” means the first time that the invention is offered for sale or sold
to anyone.
e. The anticipated date of publication should be entered here, as well as the date any
documentation was submitted for review for possible publication.
6. Reduction to practice involves actual and complete use of the invention for its intended purpose. It
usually involves physical construction of the invention or application of a process and testing the
physical embodiment or action to determine whether it performs as contemplated, but this is not
always necessary if the invention can be fully described.
9. It is recommended that all lab books and/or other records of your technology be witnessed by a
person who has read and understood your disclosure. If the principal/co-principal investigator is not
an inventor/author, he/she is often the best witness.
CONFIDENTIAL Page 4 of 4
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Patent-Invention Disclosure Form 2009 1

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Completed 17 February 2020

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