ࡱ > ] _ Z [ \ c " bjbj EP x[\x[\) R R 8 4 X L C C C zX |X |X |X |X |X |X $ Y \ n X uG -= X C uG uG X O X P P P uG v zX P uG zX P P V RW @ d * X {
B. G W fX X 0 X W x ] mH H ] X ] X P C D P WE E C C C X X L C C C X uG uG uG uG ] C C C C C C C C C R > : NO. __________ Research Office Use Only ACCT. NAME ________________
INVENTION DISCLOSURE FORM
*Note: For Use by 91 Inventors
1. TITLE OF INVENTION
2. DESCRIPTION OF INVENTION: In describing the technology, please provide when possible information covering the following points:
the general purpose;
a technical description;
the advantages and improvements over the existing methods, devices or materials; and,
the economic potential or commercial applications for the technology.
Please Use Text Box for Describing Technology
3. INVENTOR(S) (If more than 3 inventors, please download Additional Inventors Form)
4. SPONSORSHIP
Was this invention developed with the use of any research, grant or contract funds? YES NO
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(If invention is unpublished or undisclosed, include the anticipated publication or oral disclosure date and any submissions made for potential publication.)
5. DATE OF INVENTION & PUBLIC DISCLOSURE
6. REDUCTION TO PRACTICE
Has the invention been reduced to practice? YES NO
7. By signing this technology disclosure, employees of 91 understand they are subject to the Universitys policies, including, but not the least of the Universitys Intellectual Property, UNIREG 641 and Conflict of Interest Policies.
LAMAR UNIVERSITY, ITS EMPLOYEES, TRUSTEES, OFFICERS, STUDENTS, INTERNS AND CONSULTANTS EXTEND NO WARRANTIES AND ACCEPT NO LIABILITY BY PROVIDING INTELLECTUAL PROPERTY SERVICES TO INVENTORS. THE UNIVERSITY PRESERVES ITS 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.
9. WITNESS
This Invention Has Been Disclosed And Understood By:
Signature of Non-Inventor Witness _____________________________________ Date _________________
Name and Title of Witness _____________________________________________________________________
91
INSTRUCTIONS FOR THE INVENTION DISCLOSURE FORM
THE FOLLOWING INSTRUCTIONS APPLY TO THE CORRESPONDING NUMBERED SECTIONS ON THE LU TECHNOLOGY DISCLOSURE FORM
Enter a brief descriptive title to aid in identify the technology.
In describing the technology, please provide when possible information covering the following points:
the general purpose;
a technical description;
the advantages and improvements over the existing methods, devices or materials; and,
the economic potential or commercial applications for the technology.
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.
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.
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:
Conception involves the formulation, in the mind of the inventor, of the complete means for solving a problem.
The term first publication means the first time any member of the general public (if LU inventor, those outside the LU community), without restriction of confidentiality, would have been able to gain access to your written or printed enabling description of the invention.
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 (if LU inventor, those outside the LU community).
The term sale of invention means the first time that the invention is offered for sale or sold to anyone.
The anticipated date of publication should be entered here, as well as the date any documentation was submitted for review for possible publication.
Reduction to practice involves actual and complete use of the invention for its intended purpose. It usually involves physical construction of the invention and testing the physical embodiment to determine whether it performs as contemplated, but this is not always necessary if the invention can be fully described.
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.
Rev. 9/15/17 Confidential Page PAGE 1 of NUMPAGES 4
Rev. 03/03/04 confidential Page PAGE 1 of NUMPAGES 4
Name:
FIRST INVENTOR
Name:
Name:
Zip:
Home Phone:
Zip:
Work Fax:
City:
State:
Home Address:
Email:
Work Phone:
Dept:
Position:
THIRD INVENTOR
City:
State:
Home Address:
Home Phone:
Email:
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Work Phone:
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Dept:
SECOND INVENTOR
State:
City:
Home Address:
Zip:
Email:
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Work Fax:
Work Phone:
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Dept:
If yes, please explain: (Include contract or grant numbers; also, if applicable, include the principal investigator of project.)
If yes, please provide the date of first reduction to practice:
Signature:
Signature:
Date:
Inventors Name:
Date:
Signature:
Inventors Name:
Date:
Inventors Name:
Submit To: 91 Office of Research and Sponsored Administration
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2013-10-10T13:40:46-05:00
2013-10-10T18:40:48Z
2013-10-10T13:40:46-05:00
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xmp.iid:D03F274A232068118083857DF3950A38
xmp.did:D03F274A232068118083857DF3950A38
uuid:5D20892493BFDB11914A8590D31508C8
proof:pdf
uuid:4802a4cd-2e64-814f-8450-1e94a8eac24e
xmp.did:82361FFD242168118C14ADD083E84B14
uuid:5D20892493BFDB11914A8590D31508C8
proof:pdf
saved
xmp.iid:89A18299AD2068118A6D9946C5544F38
2013-09-11T14:08:22-05:00
Adobe Illustrator CS5.1
/
saved
xmp.iid:FB7F1174072068118083B62A6DE68394
2013-09-12T09:44:41-05:00
Adobe Illustrator CS5.1
/
saved
xmp.iid:FC7F1174072068118083B62A6DE68394
2013-09-12T14:40:36-05:00
Adobe Illustrator CS5.1
/
saved
xmp.iid:FF8FE6F5D22068118083B62A6DE68394
2013-09-17T09:59:41-05:00
Adobe Illustrator CS5.1
/
saved
xmp.iid:0090E6F5D22068118083B62A6DE68394
2013-09-17T10:00:33-05:00
Adobe Illustrator CS5.1
/
saved
xmp.iid:0B02B4104E2168118083B62A6DE68394
2013-09-18T08:55:58-05:00
Adobe Illustrator CS5.1
/
saved
xmp.iid:1E44DC034A2068118C14ADD083E84B14
2013-10-02T10:13:45-05:00
Adobe Illustrator CS5.1
/
saved
xmp.iid:82361FFD242168118C14ADD083E84B14
2013-10-07T16:20:18-05:00
Adobe Illustrator CS5.1
/
saved
xmp.iid:D03F274A232068118083857DF3950A38
2013-10-10T13:40:46-05:00
Adobe Illustrator CS5.1
/
Print
Adobe PDF library 9.90
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