Stanford CS 202 Class Project

Fall 2006 (David Hansen, Instructor)


(use additional sheets as necessary)

Descriptive Title of the Invention


Name / Name / Name
Street Address / Street Address / Street Address
City, State & Zip / City, State & Zip / City, State & Zip
Citizen of / Citizen of / Citizen of
Telephone / Telephone / Telephone
Facsimile / Facsimile / Facsimile

Date: ______

8David W. Hansen


Important Dates

(attach supporting documentation where possible)

Invention First Conceived: First Model or Prototype:

First Written Description: First Test or Operation:

First Sketch or Drawing: First Public Disclosure:

Disclosure of the Invention

If disclosed publicly (to persons other than company employees), please describe the circumstances:

List and describe any confidential disclosure of the invention to any person:

List and describe any publication(s) with respect to the invention, whether already completed or proposed to be completed in the future:

Summary of the Invention

Briefly describe the field(s) of technology to which the invention relates:

What shortcomings or problems of the field(s) of technology are solved or addressed by the invention?

Briefly summarize the invention in its broadest sense:

8David W. Hansen


Describe the invention in detail, including all alternative embodiments envisioned (attach additional pages of description and drawings as needed):

Describe how the invention differs from the present technology:

Describe any disadvantages, limitations or shortcomings of the invention:

Describe how the disadvantages, limitations or shortcomings described above may be overcome:

Indicate which you consider the invention to be (check only one):

___ An entirely new concept ___ A major technical breakthrough

___ An improvement to existing technology ___ A new application of existing technology

Please explain your selection above:

Describe any tests or developments that must be performed before the invention is ready for commercialization:

Describe if and when you intend to undertake such further tests or development:

List any publications, patents or patent applications, whether or not yours, which are closely

related to the invention:

(Please attach copies of any such publications, patents or applications, if available).

Inventor Signatures

Signature / Signature / Signature
Printed Name / Printed Name / Printed Name
Date / Date / Date


State of ______)


County of ______)

The undersigned have read and understand the above-described invention disclosure:

Witness Date

Witness Date

Sworn to and subscribed before me

this __ day of ______, 20__.

Notary Public

8David W. Hansen