University Research Invention Disclosure Form

1. Inventor Information

Name(s) Department Email Phone Other Inventors (Name, Department, Email, Phone)

2. Invention Title

Title of Invention

3. Invention Description

Describe your invention How does it work? (Brief explanation) What problem does it solve?

4. Development

Date of Conception Date First Reduced to Practice Has the invention been disclosed publicly? Yes No If Yes, specify when, where, and how

5. Funding and Sponsorship

Was this research funded by any agency, company, or grant? Yes No If Yes, specify sponsor(s) and grant/contract numbers

6. Publications/Presentations

Has this invention been published or presented? Yes No If Yes, provide details

7. Commercial Potential

Are there potential commercial applications? Identify any companies or organizations that may be interested

8. Additional Information

Any other relevant information