NEW INVENTION NOTIFICATION

Research Administration and Development

106 Science Building

Tel: 207-780-5084; E-mail:

1. TITLE OF INVENTION:

2. DEVELOPER IDENTIFICATION: Please expand as necessary to include all University of Maine System Developers as well as all authors/inventors existing at other institutions.

Name: Position/other title(s):

College: Academic/Administrative Unit:

Campus/Work Address: Zip Code: Citizenship:

Office Telephone: Email: Fax No.:

Home Address:

Name: Position/other title(s):

College Academic/Administrative Unit

Campus/Work Address Zip Code Citizenship

Office Telephone: E-mail Fax No.

Home Address:

Name: Position/other title(s):

College: Academic/Administrative Unit:

Campus/Work Address: Zip Code: Citizenship:

Office Telephone: Email: Fax No.:

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3. FINANCIAL SUPPORT OF THIRD PARTIES: Be specific about all of your research support that led, in whole or in part, to your Invention.

a) Federal Funds. If none, check here:

Agency

/

Contract/Grant Number

/

Principal Investigator

b) Corporate/Industrial, Foundation, or Private Agency Sponsors including any gifts. If none, check here:

Agency

/ Principal Investigator

c) University funding sources. (e.g. University or other State funding sources, seed grants, bridge grant, faculty start-up/development packages.) If none, check here:

Funding Source(s)

/ Principal Investigator

d) If work is to be continued. What other funding sources do you anticipate will be used? If none, check here:

4. PRE-EXISTING WORKS OF THIRD PARTIES:

a) Outside sources of materials or confidential information received under spoken understanding, written agreements, or other constraints. (e.g. Material Transfer Agreements, Confidential Disclosure Agreements, Consulting Agreements, contracts, licenses, letters, e-mails.) If none, check here:

Computer Software / Equipment / Supplies

or Biological Materials Received

/ Source / Type of Agreement & Date

b) List any known pre-existing intellectual property of third parties which your invention derives from, integrates or otherwise would be required to utilize. If none, check here:

5.  CHRONOLOGY OF YOUR INVENTION: Please include dates and describe circumstances for each question as applicable.

a)  When did you first arrive at the idea for the invention?

b)  When did you first complete a prototype or otherwise demonstrate the function of the invention?

c)  When did you first complete a written description of the invention?

d)  When did you first communicate either an oral or written description of the invention to others? Please indicate whether there was an understanding of confidentiality.

e)  When did you first publish a written description of the invention?

f)  When was the invention first offered for sale or publicly used?

g)  What publications, presentations and/or other disclosures are planned for the future?

6. DETAILED DESCRIPTION OF THE INVENTION:

a) Please describe the scientific theory, discovery, or newly discovered property upon

which the invention is based.

b) How can this discovery be applied in practical terms?

c) What are the advantages of using the invention over products that carry out the same or similar function?

d) Please describe any other practical applications.

e) Identify your competition. What companies or research organizations may be developing similar technologies or work products that will compete with your Invention?

7. COMMERCIAL INTERESTS:

a) Who have you contacted about this invention?

Name

/ Organization / Phone

b) Are there plans to use this invention commercially? Yes No

Please describe:

c) Please list any persons or commercial entities you believe may be interested in this Invention. Provide names and phone numbers if known.

Name

/ Organization / Phone

d) Please list any people or commercial entities which you do not wish to be

contacted regarding this technology.

Name

/ Organization

8. OTHER RELEVANT INFORMATION:

a) Please list below and attach any relevant grant applications, manuscripts, abstracts, presentations, etc.

b) Please include any other relevant information.

9. SIGNATURES:

All developers affiliated with the University of Maine System during the course of developing this invention must sign below.

In consideration for USM to accept this New Invention Notification Form I hereby assign and promise to execute any additional documents necessary to make and record the assignment of my rights in this invention to the University of Maine System pursuant to the University of Maine System Statement of Policy Governing Patents and Copyrights. I understand and agree that all rights, obligations, and financial interests, if any, pertaining to or derived from the invention are as determined under University of Maine System Policy.

All statements and information I have made or provided in this form are true and complete to the best of my knowledge. I agree to assist the University of Maine System, appropriate campus offices, and their agents in the evaluation, possible protection, and commercialization of the invention as described in this New Invention Notification Form.

a) University of Maine System Developers

Name (print or type) / Signature / Date
______/ ______
______/ ______
______/ ______
______/ ______
______/ ______

b) Current Academic/Administrative Unit Director

______

Signature/Date Printed Name

______

Department/Academic/Administrative Unit Title

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