Baylor Research Institute
Invention Disclosure Form
This form is a legal document which is used tonotify BRI of a potential invention,initiate the processes of technology evaluation, market assessment, intellectual property protection, and invention reporting to granting agencies.Please complete the form in its entirety and e-mail it to .
- Invention Information
Title of Invention:
Date of conception:
Briefly summarize the purpose of the invention. Identify the immediate and/or future applications of this invention.
Identify how the invention is different, novel, and/or better than existing technologies.
What are the advantages of the invention over existing technologies?
Provide a detailed description of the invention, including reaction conditions, materials, drawings or chemical formulas, etc., that are pertinent to the practice of the inventions. Use the space below or provide an attachment(s).
Provide a description of the most preferred or best way of practicing the invention (e.g., indications, usage, etc.).
Provide a description of alternative ways of practicing the invention (other reaction conditions, different starting materials, other compounds/compositions of the same type which can be made).
- Inventors and signatures
List the person(s) who conceived of and contributed to the conception of the invention. List the primary inventor first. Please sign and date.
Name: (Last, First, MI, Suffix)Department:
Business Address:
E-Mail Address:
Office Phone Number:
Home Address:
Citizenship:
Percent of time employed at Baylor:
Other employment, if any:
Signature and date:
Name: (Last, First, MI, Suffix)
Department:
Business Address:
E-Mail Address:
Office Phone Number:
Home Address:
Citizenship:
Percent of time employed at Baylor:
Other employment, if any:
Signature and date:
Name: (Last, First, MI, Suffix)
Department:
Business Address:
E-Mail Address:
Office Phone Number:
Home Address:
Citizenship:
Percent of time employed at Baylor:
Other employment, if any:
Signature and date:
Name: (Last, First, MI, Suffix)
Department:
Business Address:
E-Mail Address:
Office Phone Number:
Home Address:
Citizenship:
Percent of time employed at Baylor:
Other employment, if any:
Signature and date:
- Related ART
Identify any patents, printed, or oral disclosures thatare closely related to the novelty and/or commercial use of the invention.
- Previous Disclosure
Has the invention been disclosed in an abstract, article, grant, poster, or thesis? If yes, provide the type of disclosure and the date. Please attach a copy of the disclosure.
Has the invention been disclosed at seminars, conferences, or to industry representatives? If yes,provide the type of disclosure and the date and/or name(s) of the company(s) and their representative(s).
- Future Disclosure
Will the invention be published in an abstract, article, grant, poster, or thesis? If yes, provide the type of disclosure and the date. Please attach a draft.
Will the invention be disclosed at seminars, conferences, or to industry representatives? If yes,provide the type of disclosure and the date and/or name(s) of the company(s) and their representative(s).
- Sponsorship/Funding
Was the development of the invention supported by a grant or contract outside of BHCS?
Sponsor/Funding Agency:
Grant/Contract Number:
Sponsor/Funding Agency:
Grant/Contract Number:
Sponsor/Funding Agency:
Grant/Contract Number:
For Administrative Use Only
Date reviewed by patent committee:
Outcome of patent review:
Date entered into iEdison:
Baylor Research InstitutePage 1 of 6Form #Adm009
3310 Live Oak, Suite 501Version 07
Dallas, Texas 75204Effective: 08/24/11
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