Faculty Startup Invention Disclosure Template

1. Faculty Information

Faculty Name Department Email Phone

2. Title of Invention

3. Date of Conception

4. Description of the Invention

Problem Addressed Proposed Solution Unique Features/Novelty

5. Development Stage

Current Development Stage

6. Funding & Sponsorship

Sources of Funding

7. Inventors & Contributors

Co-Inventors (Name, Department, Email)

8. Commercialization Interests

Interest in Starting a Company Potential Market Applications

9. Prior Public Disclosure

Has any part been disclosed publicly? Details of Public Disclosure (if any)