Case No. (Monash Innovation use only)
WS

Invention Disclosure Form

Complete this form and send (T:03 9905 3088).

If you have already initiated a discussion with your Faculty Industry Engagement Team or with Monash Innovation, please provide their name and copy this form to them:

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  1. INVENTORS

List all inventors and their position at the time of the invention. Nominate one person as the main contact. If you are unsure whether an individual is an inventor, please list details but prefix with a question mark. If the inventor also had an external appointment at the time of the invention, please indicate. Add rows if needed.
An inventor is an individual without whose intellectual and creative input the invention would not have been made in its present form. They must have conceived or contributed an essential element of the invention, either independently or jointly with others, during the evolution of the invention or its reduction to practice. Co-authors of publications are not necessarily inventors.
Inventor(s) - Name and initials / Student / Position / External / Department / Phone / Fax / Email
  1. INVENTION

Title - brief and descriptive, to aid in identifying the invention (~6 words).
Date the inventor(s) devised the essential concepts.
How is this documented?
In whose laboratory notebook is the experimental data recorded?
What is the current state of the invention? / Idea Proven concept Working prototype
Attacha document that includes:
  • a brief description of the invention – why it was developed and what problem it will solve;
  • key features;
  • the closest known technology and reasons your invention is better;
  • how you envisage your invention could be used;
Also attach any relevant manuscript drafts, presentations, drawings etc.
  1. DISCLOSURES

Have any details of any of your research been disclosed publicly? Provide brief details.
In most countries a patent application must be filed before any oral, online or printed disclosure / publication is made available externally to the university (unless under cover of a confidentiality agreement). Contact us if you are unsure.
In a journal (online or in print):
At a conference or seminar, as a publication, abstract, poster, etc. (including online before the conference):
In a PhD, Master’s thesis or project write up:
In any other online or commercial discussion:
Are there any publications or disclosures of your research planned? If so, when, where and in what form?
  1. PRIOR ART SEARCH

Please do an on-line search for:
  1. Publications or products that are closely related to your work;
  2. Patents closely related to your work using Quick Search on Title and Abstract; select both US and the WIPO options below).
Please list keywords used and results obtained. Also explain how your invention differs from each article/item identified.
  1. INDUSTRY ENGAGEMENT / COMMERCIALISATION

List any companies you think may be interested in the work or are active in the area. If possible please give contact information (we’ll consult you before we get in touch with them).
  1. SPONSORSHIP OF THE RESEARCH

Was the invention developed using any research grants/contract funds? / Yes No If Yes, please provide details below.
Contract / Sponsor(s) / Project title / Contract number / Principal investigator / Date started
Is the invention subject to any other agreements (e.g. material transfer agreement, consultancy, confidentiality agreement)? / Yes No If Yes, please provide details below.
  1. SHARE OF INCOME and SIGNATURES

Please have all available inventors fill in details below. For anyone who is unavailable, fill in their name and leave other details blank - we will obtain details subsequently. Add additional signature boxes as needed.
We would like to distribute the inventors’ share of any resulting income as follows:
Equally Other (give details):
By signing below I confirm that:to the best of my knowledge the information given in the form and attachments is correct and accurate, and all inventors have been named.
Print name:
Inventor’s signature:
Date:
Citizenship (needed for patent filing): / Print name:
Inventor’s signature:
Date:
Citizenship (needed for patent filing):
Print name:
Inventor’s signature:
Date:
Citizenship (needed for patent filing): / Print name:
Inventor’s signature:
Date:
Citizenship (needed for patent filing):

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May 2017