Report of Invention

Please complete all sections and submit an electronic version of this form to the Office of Technology Transfer for review and comments/suggestions. A final paper version of this Invention Report will be routed for final signatures upon completion of the review process. Concurrent with acknowledgement of receipt by OTT, a copy of this Invention Report will be routed to the Office of the University Attorney for review and retention.

Report of Invention

 
1. Report Date: (Insert date of this disclosure)
 
2. Inventorship: (Identify all inventors below. In Section 2 (a), if all inventors are UNC Charlotte students, staff and/or faculty, place a checkmark next to the first item. If inventors include students, staff, and/or faculty external to UNC Charlotte, place a checkmark next to the second item. In Section 2 (b), list contact information for all inventors, identifying the primary contact person in Section 2 (b)(i))
 
a. UNC Charlotte Only _______       UNC Charlotte + External _______
b. Inventors:
 
(i) Full Name: ** Main Contact Person
 
Affiliation, College, Dept.: ______________________________________
 
Home Address: _______________________________________________
 
Phone/Fax/Email: _____________________________________________
 
Citizenship: __________________________________________________
 
(ii) Full Name: ________________________________________________
 
Affiliation, College, Dept.: ______________________________________
 
Home Address: _______________________________________________
 
Phone/Fax/Email: ______________________________________________
 
Citizenship: ___________________________________________________
 
(iii) Full Name: ________________________________________________
 
Affiliation, College, Dept.: ______________________________________
 
Home Address: _______________________________________________
 
Phone/Fax/Email: ______________________________________________
 
Citizenship: ___________________________________________________
 
(iv) Full Name: ________________________________________________
 
Affiliation, College, Dept.: _______________________________________
 
Home Address: ________________________________________________
 
Phone/Fax/Email: ______________________________________________
 
Citizenship: ___________________________________________________
 
3. Sponsorship: (Identify any and all sponsors below who have contributed cash and/or in-kind funding/assistance for the efforts associated with this invention. If none, write "n/a" in all spaces provided.)
a. Sponsor Name(s): _____________________________________________
b. UNC Charlotte Contract/Grant No.: _____________________________________
 
c. Funding Period: _______________________________________________
 
d. Principal Investigator (PI): ______________________________________
 
4. Title of Invention: ____________________________________________________ 
  

Patent Primer

According to the United States Patent and Trademark Office ("USPTO"), patents may be issued for inventions that are novel, nonobvious, adequately described to allow one of ordinary skill in the art to make and use the invention, and claimed by the inventor in clear and definite terms. Patentable inventions include: process, machine, article of manufacture, composition of matter, and improvement of the preceding items. Such patents are defined as "Utility Patents". Patent protection is also available for: (a) ornamental design of an article of manufacturer ("Design Patents"), (b) asexually reproduced plant varieties ("Plant Patents"), and (c) business processes and models ("Business Patents"). Items that cannot be patented: laws of nature, physical phenomena, abstract ideas, literary/dramatic/musical/artistic works (which can be copyright protected.)
 
Pursuant to University Policy #301, "Patent and Copyright Procedures" of the University of North Carolina at Charlotte ("UNC Charlotte"), The University of North Carolina Patent and Copyright Policies, and all other UNC Charlotte employment and intellectual property policies and procedures, I/we hereby disclose details about the following invention:
 
5. Invention Abstract: (Attach a one paragraph summary description of your invention. Identify whether invention is a new process, composition of matter, a device, software, one or more products, a new use for or an improvement to an existing product or process.)
 
6. Field of the Invention: (Describe to what field the invention relates.)
 
7. Description of Related Art: (Describe all known related, prior art, including published literature, commercial products, and related patents and other forms of intellectual property, and conclude with a summary listing of all known related art.)
 
8. Detailed Description of the Invention: (Describe in detail the nature, operation, preferred embodiment, and applications of the invention. What technical problem does this invention solve, and for whom is this a problem? Include details of how this invention is nonobvious to those skilled in the art, novel, and useful – how does it differ from the prior art?)
 
9. Figures and Drawings: (Attach all related figures and drawings that help to describe the nature, operation, and applications of the invention.)
 
10. Reduction to Practice: (Has invention been reduced to practice? If so, include or attach a copy of experimental/prototype data or photos/graphics – or reference such data’s location.)
 
11. Publication and Presentation: (Note that public disclosure of an invention initiates a twelve (12) month window in which to file for patent protection within the U.S. In general, any public disclosure or placement on sale precludes foreign filing rights.)
 
a. Prior: (Indicate details of any full or partial disclosure of this invention by any of the inventors, including but not limited to: manuscript, article, report, grant application, thesis/dissertation, abstract, demonstration, sales catalog, news release, or oral (private or public) presentation. Please indicate which you have available, and if possible, provide a copy to the OTT with this Invention Report. Include all relevant dates of disclosure and recipient names or those in attendance (for presentation.).)
b. Planned: (Indicate details of any planned disclosure of this invention by any of the inventors. Include all planned dates of disclosure, as well as recipient names or planned attendance
 
12. Regulatory Requirements: (Does this technology require approval by regulatory agencies EPA, USDA, FDA, OSHA, other? If yes, please explain.)
 
13. Initial Market Assessment:
 
a. Potential Markets: (Briefly identify a few potential markets for this invention and how this invention addresses each market’s specific needs.)
 
b. Competition: (Identify all known competing approaches to solving the problems addressed by this invention, as well as all commercial competitors and prospective competitors.)
 
c. Potential Licensees/Assignees: (Identify any and all potential licensees/assignees of this invention. Reference any existing or expired partnership or other agreements with respect to this invention. Are such agreements still active?)
 
14. Personal Goals: (Check any and all that apply. It is important to note that the University, at its sole discretion, may commercialize its inventions in any manner consistent with its mission, objectives, policies, and rules and regulations; however, the personal goals of each inventor are important considerations in this process, and are therefore documented below.)
_____ I simply wish to document and file this invention report
_____ I would like the University to consider prosecution of patent applications, in its name, for this invention in:
_____ the U.S., because: (Provide rationale for request)
 
 
_____ internationally, because: (Provide rationale for request.) 
 
 
_____ I would like the University to consider commercializing this invention via:
 
 
_____ new company start-up without my direct involvement.
_____ new company start-up with my direct involvement, in the role of _____ president/CEO, _____ CTO,      _____ consultant.
_____ licensing/assignment to commercial entity in exchange for
_____ stock / equity _____ royalties / licensing fees
 
 Please add any other comments below, and attach any related drawings, publications, or materials: 
 
15. Inventor Signatures: (By signing below, I acknowledge that I am one of the inventors of the invention reported herein. I understand that the University of North Carolina at Charlotte owns the rights to, and may obtain protection for, all intellectual property developed by its students, staff and faculty subject to the provisions of University policies and procedures. By signing below, I hereby agree to execute a formal assignment of all rights to the invention to the University, unless so noted below in Section 19 "Request for Waiver".)
 
(i) Sign: _________________________     Date: _______________  Print: _________________________
 
(ii) Sign: _________________________     Date: _______________ Print: _________________________
 
(iii) Sign: _________________________     Date: _______________ Print: _________________________
 
(iv) Sign: _________________________     Date: _______________ Print: _________________________
 
16. Signature of Person Witnessing This Disclosure: (Obtain the signature of a colleague knowledgeable in the subject matter of this invention, who has read and understands the concepts presented herein, and who may be called upon to support the claims herein throughout the patent process.)
 
Sign: _________________________     Date: _______________
Print: _________________________
 
17. Department Chairperson: (Obtain the signature of your department’s Chairperson to acknowledge his/her understanding of this disclosure and the interrelationship between this invention, any related sponsored research, potential conflicts of interest, and University duties.)
 
Sign: _________________________     Date: _______________ Print: _________________________     Dept.: _______________
 
18. Office of Technology Transfer Signature and Date Recorded:
 
Sign: _________________________     Date: _______________ Print: _________________________
 
19. Inventor Request for Waiver: (Optional: If you believe that the invention was made outside the general scope of your University duties, conceived without the use of University time, facilities, staff, materials, University information not available to the general public, and without the use of funds administered by the University, check the space below, sign and date where shown (in addition to signing above), and provide a short explanation of the circumstances under which the invention was made and developed, resources employed, and your University duties at the time of the making of the invention. If you would like the University to consider patent prosecution of this invention in its name, check the appropriate space below as well.)
 
_____ I/we hereby request a waiver of University rights to this invention
_____ I/we would like the University to consider prosecution of patent applications (I/we understand that assignment of my/our rights will be required)
 
 Signed:______________________     Date:_______________________
 
Signed:______________________     Date:_______________________
 
Signed:______________________     Date:_______________________
 
Signed:______________________     Date:_______________________
 
 
Please provide a list of UNC Charlotte faculty members with research interests in this field who might be willing to serve on a technical review committee for this invention.
 
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