Intellectual Property Disclosure Form Page 2
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2Are you aware of related developments by others? Yes ______ No _______ If yes, please
give citations. (Copies of any relevant patents or publications would be appreciated).___
_________________________________________________________________________________________
III. Sponsorship
If the research that led to the invention was sponsored, please fill in the details and
attach a copy of the contract or agreement if possible.
Funding Agency _________________________________________________________________________
Funding Agency contact/grant no.___________________________ TU Acct. No. ________________
Title of Sponsored Project ______________________________________________________________
Principal Investigator _____________________________________ Phone ______________________
Has the invention been disclosed to industry representatives? Yes ______ No _______ If
yes, please provide details, including the names of companies and their representatives.
_________________________________________________________________________________________
_________________________________________________________________________________________
IV. For Our Records
Names of inventors
1. ______________________________ Signature ____________________ Date ___________________
2. ______________________________ Signature ____________________ Date ___________________
3. ______________________________ Signature ____________________ Date ___________________
Contact for more information __________________________________ Phone ___________________
Mailing Address for inventor(s) _________________________________________________________
Intellectual Property Committee
Reviewer’s ___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
IPC No. ___________________________________
Date ___________________________________
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