PRINCETON UNIVERSITY

OFFICE OF Technology Licensing and Intellectual Property

CONFIDENTIAL INVENTION DISCLOSURE FORM

1. Title of Invention:

Inventor(s) Name(s)*

Princeton University Address

Email Address and Telephone Number

Home Address

* The Office of Technology Licensing and Intellectual Property will contact the first named

    inventor to discuss patenting and licensing.

Please indicate if any Inventors are not Princeton University employees.  If not, please indicate their corporate/university affiliation or Princeton University status, if any, (i.e. Visiting Researcher, etc.).

2. Sponsorship. Was the work that led to the invention sponsored?  List all sponsors below.

Sponsor                       Award or Account Number                                                                

            a)         _________________              ______________________   

            b)         _________________              ______________________               

3. Publications, Oral Presentations, Poster Sessions, Web Postings.

A) Have you described the invention in a publication, oral presentation, poster session, or spoken to the press or media?  Has it been posted on a website?  What was the date of publication,  presentation or posting?  Was it described in specific or general fashion?  Include abstracts of talks, news stories, etc.  Be sure to include copies of any publications, label them collectively as Attachment A.

B) Any planned future publications or public disclosure? YES____ NO_____ If yes please include a date when the publication will go into the U.S. mail for distribution and the date any public disclosure such as a talk will take place. Please attach copies as Attachment B.

4. Category and General Description. 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?

5. Utility. What are possible uses for the invention? In addition to immediate applications, are there any other uses that might be realized in the future?

6. Novelty. Pick out and expand on novel and unusual features. How does the invention differ from present technologies currently being used in industry? What problems does it solve, or what advantage does it possess?

7. Method of Synthesis, Assembly, or Process. If the invention is a composition of matter, a device, or a product, how is it made? If the invention is a process, what are the steps involved?

8. Limitations. Does this invention possess disadvantages or limitations? Can they be overcome? How?

9. Experimental Verification. Have you tested the invention experimentally? YES____ NO_____ If yes, describe below. Have you constructed a prototype, model, or test samples which are available for examination? YES____ NO_____ If yes, describe below.

10. References. Are you aware of any inventions or publications by others that are related to this invention? Please attach copies of any documents that you have. Label this as Attachment C.

11. MTAs.  Was the invention made with any material or biological substance obtained through a Material Transfer Agreement?  Please provide the name of the provider, their affiliation and a copy of the Agreement as Attachment D.

12. Possible Means of Commercialization. How do you envision that the invention might be used in a commercial product or a process for producing a product?  What advantages does this invention have over existing technologies?

13. Potential Licensees. Have you described the invention to any industry representatives?  Did you describe it in a specific or a general fashion?  Please provide the names and contact information for the people that you spoke to. Do you know of any other companies that might be interested?

14. Abstract. Please provide a brief (less than one page) abstract of the invention. NOTE, THIS ABSTRACT IS INTENDED FOR MARKETING PURPOSES UNDER NONCONFIDENTIAL SITUATIONS. While it is important to include the novel nature of the invention, a general description, intended or proposed uses and utility, the abstract must be a NON-ENABLING DISCLOSURE. Please DO NOT include the essential elements which would allow someone to practice the invention or reproduce the material without a license.

I (We) hereby agree to assign all right, title and interest to this invention to Princeton University and agree to execute all documents as requested, assigning to Princeton University our rights in any patent application filed on this invention, and to cooperate with the Princeton University Office of Technology Licensing and Intellectual Property in the protection of this invention.  Princeton University will share any royalty income derived from the invention with the inventor(s) in accordance with the Princeton University Patent Policy.

_____________________________          __________                

Inventor’s Signature                                                     Date

____________________________          __________                  

Inventor’s Signature                                                     Date

_____________________________          __________                

Inventor’s Signature                                                     Date