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INVENTION DISCLOSURE FORM
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(to be completed and forwarded to Alla Kan,
HB 6210)
Inventors(s):
Name:
Dartmouth Address:
Phone:
Name:
Dartmouth Address:
Phone:
Descriptive Title of Invention:
Description of Invention: Please provide a concise description of your
invention including an explanation of the nature, purpose and operation of
the invention, a summary of results achieved, features believed to be novel,
further experimental work planned, and any additional information which you
believe might be helpful in deciding whether a patent application should be
filed. Additional sheets can be used, but each must be attached to this form
and each must be signed and witnessed.
Publication Information: Please list any papers, abstracts, etc.
describing the invention which have been published or submitted for
publication. Include the title, journal and date or estimated date of
publication.
Is there an Internet bulletin board available for these publications? If so,
please give an approximate date of anticipated electronic exposure.
Please indicate whether an oral presentation (including slide or poster
presentations and thesis defense) of invention has been or will be made, and
to whom and when.
Is there a pre-meeting Internet bulletin board available for this event? If
so, please give the anticipated date of electronic exposure.
NOTE: Printed publications, abstracts, oral presentations or other public
disclosures may result in immediate loss of rights to patent protection.
Student theses are also considered publications once catalogued in the
library. Please attach a copy of any paper, abstract or other printed
publication, including a rough draft if publication is not yet in final form.
Use of Biological Materials: Did you use any biological materials
received from outside of Dartmouth
for this Invention?
Did you sign any Agreements or receive any correspondence regarding your
receipt of these materials? (If yes, please attach a copy.)
Research Support: Please designate all sources of funding for the
invention.
Sponsor: Contract No.:
Sponsor: Contract No.:
Sponsor: Contract No.:
Commercial Potential of This Invention: Please provide your assessment
of the commercial potential of the invention:
Assignment: I (we) hereby agree to assign the above invention to The
Trustees of Dartmouth College.
Inventor(s) Signature(s) Read, Understood and Witnessed
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