Please complete, sign, and return this form (with attachments) to TCO:
New Technology Disclosure
Technology Commercialization Office
The City University of New York
555 West 57th Street, Suite 1407
New York, NY 10019
Tel: 646-758-7910
Fax: 646-758-7907
Email:
Please ALSO send the completed NTD form electronically (if available) to TCO:
E-mail:
To the Inventor(s):
Please complete this Software Invention Disclosure Form as completely as possible. It is important to provide as much information as possible to facilitate review, analysis and protection of the software (copyright, patent). Though certain signatures are required for processing, sending an electronic copy of the disclosure to helps facilitate processing efforts.
This is a confidential, proprietary, non-public document. Except with respect to obligations to the sponsor(s) of your research, its contents will not be communicated in any way outside of CUNY.
Please apply the following copyright notice to all existing copies of the software:
© [YEAR]
City University of New York
All Rights Reserved
The above copyright notice should be placed in the following locations:
(1) Source Code: top, bottom and regularly throughout
(2) Title Screen
(3) Labels on Diskettes and CDs
(4) Documentation, User’s Manual or Other Printed Materials
For Internal Use by TCO:Date Received:
TCO Number:
1. Title of Software Program:
2. Date of Creation: earliest conception date
INVENTOR(S) DETAILS
3. List all inventors. If more than 3 inventors, please use a separate sheet
INVENTOR 1 / INVENTOR 2 / INVENTOR 3FULL NAME
WORK PHONE
ADDRESS
CELL PHONE
CITIZENSHIP
SOCIAL SECURITY NUMBER
CUNY DEPARTMENT
PRIMARY CONTACT FOR THIS INVENTION
DESCRIPTION OF SOFTWARE
4. Please provide a comprehensive summary of the software, particularly pointing out program characteristics such as software use and utility, functionality, and anything else that identifies the strengths of the software. Use as much space as necessary.
5. What are the immediate and/or future applications of the invention, and what problem does it solve?
6. What are the advantages and novel features of the invention over other current/anticipated technologies? Please describe competing technologies or procedures (include names of products, software, etc.) and their deficiencies, as well as those making or selling such products.
7. Are there any open-source elements included/embedded in the Source Code If yes, please list all third party code embedded in or accessed by the disclosed software when such software is run. This list must include, all open source code (free executable code, public domain code, library code and all other executable or source code not written by any of the Inventor(s) listed in Section 3 of this form) directly embedded in the software when it is executed.
If the code is not available on the web, please provide copies of any license agreements governing your use of the third party code
8. Describe language used to develop application and platforms on which it will run. Is the software easily portable to other platforms? Does it require other products/software to run? What are the system requirements for the software?
9. Are there any documents/manuals describing the software and its operation? Attach any supplemental papers, drawings, etc. to the Form.
10. Please mention the location of this source code (disc, server, PC)?
(Note: Attach to this form a CD/DVD containing a copy of the entire source code of the disclosed software or CD/DVD of the executable version of the software)
11. (a) Is this disclosure related to an earlier CUNY disclosure? If yes, identify and list showing technology identification number and title.
(b) Is this disclosure related to any earlier software or invention disclosure of another institution?
DEVELOPMENT OF INVENTION
12. (a) Please check the one which best describes the stage of the development of the software.
Concept Beta Test
Research Tool Ready to License Product
Prototype
b. Please check the one which best describes the software documentation.
No Documentation Partial Documentation
Full Documentation
(c) Also describe the plans for continued development. Please describe developmental milestones that are expected to be reached within six months, and whether you have access to the necessary resources for such development.
THIRD PARTY INVOLVEMENT
13. CUNY is required to report inventions made using government funds to the relevant government agency, including providing them with a confidential copy of the disclosure. If an invention is made using industry or foundation funds, we will be obligated to report such inventions to the sponsor, in according with the associated research grant/contract. Please identify the sponsor of the invention, as well as the relevant grant/contract numbers.
Title of Grant / Granting Agency / Grant NumberAgency Grant # / RF/Campus Prsy #
Check the following:
U.S. Government [ ];
Industry Sponsor [ ];
CUNY [ ];
Personal [ ]
Check the following:
U.S. Government [ ];
Industry Sponsor [ ];
CUNY [ ];
Personal [ ]
14. Please list any agreements that are in place or are being processed or drafted that might be related to the technology, such as Consulting Agreement, Confidentiality Agreements, Sponsored Research Agreements, and Fee-for-Service Agreements. Please include company/institution name and agreement date. It is critical to identify any encumbrance on the technology as early as possible.
PUBLIC DISCLOSURE
15. Please list the titles and dates of relevant publication(s) made by you or colleagues related to the invention – including publication on websites, or publication of abstracts or poster presentations, and oral presentations at conferences. Please attach copies of published or submitted versions. Valid patent protection depends on accurate dates of public disclosure.
16. Please list dates of all disclosures you have made to individuals or entities NOT employed by CUNY, and identify the recipients of such disclosures. Please include informal discussions either held on or off CUNY premises (please indicate if a Confidentiality Agreement was in place or if an agreement is needed for upcoming discussions).
17. Please list any literature and/or patent searches done by the inventors or other individuals or entities conducting research/development in the field related to this invention (patents can be searched at www.uspto.gov and ep.espacenet.com). Please identify Key Words used for the searches.
18. Please list any publications of third parties that are similar to the invention, or disclose elements of the invention, and that therefore may be relevant prior art.
COMMERCIALIZATION
19. Please describe the likely end users of the software.
20. What do you see as the commercial uses of the software?
21. Please indicate (choose one) the anticipated distribution model for the current version of the software.
Open Source License Beta Test License Academic Use License
License to Company Software Reseller License
22. Please list any industry contact(s) that may be interested in licensing or sponsoring future research (include name, company/affiliation, title, phone/email information).
REVENUE DISTRIBUTION
CUNY will share any royalty income derived from the invention with the inventor(s) according to CUNY IP policy.
DECLARATION SIGNATURE OF INVENTOR(S)
Attach additional sheets if there are more inventors. It is the inventor’s responsibility to notify TCO of any address changes.
I hereby declare that all statements made herein of my own knowledge are true and that all statements made on information and belief are believed to be true.Declaration of CUNY inventors: In view of my (our) obligations under the CUNY IP Policy (copy available upon request), I (we) hereby assign all rights, title and interest to this invention to the Research Foundation of CUNY (RFCUNY), and agree to execute all documents as requested for assigning to RFCUNY my (our) rights in any patent/copyright application(s) filed on this invention, and to cooperate with the Technology Commercialization Office (TCO) in the protection and commercialization of this invention.
Declaration of Non-CUNY inventors: I have disclosed (or will disclose) this invention to my home institution.
The following information will be used for patent/copyright purpose and revenue distribution. Please note that % Contribution indicates the percentage that each inventor should receive from the inventor share of the commercialization revenue. If unspecified on this document, all inventors will equally share all such revenue.
Inventor 1 / Inventor 2 / Inventor 3Full Name
Signature
% Contribution
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