Northwestern University Funds, Facilities

SOFTWARE

DISCLOSURE FORM

NU # ______
Date Received ______
Shading appears on the screen to identify the fields.
This shading does not print. / Please COMPLETE, SIGN and SEND with
any relevant attachments by EMAIL to:

TITLE OF SOFTWARE
CONTRIBUTING DEVELOPERS
(Please add additional rows to this table if there are more than four developers.)

NAME

/ SCHOOL / DEPARTMENT / POSITION
SOURCES OF SUPPORT, RESEARCH SPONSOR AND GRANT NUMBERS
(All Funding Sources and Grant Numbers must be correct)

SOURCE OF FUNDS

/ NAME AND GRANT NO.
(if applicable)

Federal Agencies:

Foundation:

Corporate:

Northwestern University Funds, Facilities:

Other:

RESEARCH ADMINISTRATOR(S) ON RELATED GRANTS, IF AVAILABLE
NAME

UNIVERSITY EMAIL

/

UNIVERSITY PHONE

DESCRIPTIVE ABSTRACT OF SOFTWARE
Brief summary of the objective of the software, the circumstance under which it was developed, its applications or utility.
PUBLIC DISCLOSURE
1. Has the software been discussed, or otherwise disseminated within Northwestern University?

TO WHOM DEMONSTRATED

/

DEPARTMENT/CENTER/SCHOOL

/ DATE
2. Has the software been discussed, or otherwise disseminated outside of Northwestern University?

TO WHOM DEMONSTRATED

/

ORGANIZATION

/ DATE
3. Does anyone have a copy of this software? YES NO

NAME

/

DEPARTMENT/ORGANIZATION

/ DATE GIVEN
4. Is any disclosure of the software planned or scheduled within the next six months (i.e., journal, oral presentation, conference abstract, disclosure to industry, grant proposal, other)? YES NO
If so, note date and place below.

DATE

/

PLACE

5. Do all present copies of the software bear the proper notice of copyright, i.e., “Copyright © 20xx by Northwestern University. All Rights Reserved.”? YES NO
If so, note date and place of copyright notice below. *Note Reminder of Copyright Notice & Terms below*

DATE

/

PLACE

*REMINDER TO INCLUDE COPYRIGHT NOTICE AND TERMS OF USE IN SOFTWARE*

INVO recommends that all software developed on campus should be bear a clear, standardized copyright notice, and include terms of use embedded within each file of the software source code (if source is provided) and on an external label, or a “readme.txt” file if distributed over a network. Accompanying documentation should also contain a copyright notice and disclaimer.

Please see INVO’s website [at LINKS] for more information and examples.

DETAILS ON SOFTWARE CREATION AND ANY RELEVANT DISCLOSURES / PUBLICATIONS
Provide the year of creation and the exact date of first publication, if any, for the computer program that is being disclosed.
Has an earlier version of the software been disclosed to INVO? YES NO
If yes, please describe what aspects are the same:
COMPONENTS THAT ARE NOT ORIGINAL
Identify any program code, data, files or other incorporated elements (including, for example, runtimes, voices or other sounds, graphics or other images) not original to the developer(s). Please append copies of grant of permission releases or licenses for each use.
Indicate if this software is a modification or an improvement to an existing work. If so, identify that work and its developer(s).
TECHNICAL ABSTRACT OF SOFTWARE
Please provide an abstract addressing content below and submit as an attachment.

1. Describe the methods used by the software.
2. Describe what hardware configuration is required to operate the software.
3. Identify what operating system is required.
4. Indicate what utilities are required.
5. If this software is currently being distributed as part of an open source project, please indicate (1) which open source license(s) is/are being used, (2) which components or features of the software are being open sourced, and (3) which components or features are not.
6. Identify what programming language was used.
7. Indicate in what code format you recommend the software be distributed (e.g., object code only, object and source).
8. Assess how user-friendly the software is relative to its intended users. (e.g., does it have “Help Windows” or a written “User’s Manual”? Please provide a copy of the User’s Manual if available).
9. Describe the current state of the software’s development (i.e., fully functional, fully tested by you, tested by others).

CELERA DATABASE

Did this software disclose use information obtained from any Celera database? YES NO

If yes, please describe:
MARKETING INFORMATION
What are the unique benefits the software offers to users? Compare it to alternative products or techniques. Address why someone would want to use this program.
Does it have classroom use, laboratory use, corporate applications, or other fields of use? If so, please describe.
Does the software possess disadvantages or limitations? Can they be overcome? How?
Will the software require maintenance? YES NO If so, what level of support (on-site, telephone, etc.) will you provide?
Describe potential end-users.
POTENTIAL PUBLISHERS, DISTRIBUTORS AND/OR END-USERS
If you know any potential publishers, distributors, and/or end-users of this software? If so, please list.
COMPANY

CONTACT

PHONE / EMAIL
POTENTIAL PUBLISHERS, DISTRIBUTORS AND/OR END-USERS
COMPANY

CONTACT

PHONE / EMAIL
POTENTIAL PUBLISHERS, DISTRIBUTORS AND/OR END-USERS
COMPANY

CONTACT

PHONE / EMAIL
This disclosure is submitted pursuant to the Northwestern University Patent and Invention Policy and the Northwestern Copyright Policy and is subject to all the terms of those Policies:
If this disclosure is accepted by the Innovation and New Venture Office at Northwestern University:

1. I/We hereby agree to execute all necessary documents required to perfect rights in any intellectual property described in this disclosure, including assignment to Northwestern all rights in any patent application filed on the information contained in this disclosure (if applicable); and
2. I/We further understand that I/we may be required to assign rights to the copyrightable works described in this disclosure to Northwestern if I/we continue to work with Northwestern to market and/or commercialize the copyrightable works disclosed herein.

DEVELOPER 1 * Please sign in INK PEN, DIGITAL SIGNATURE (Example: /John Brown/), or ELECTRONIC SCANNED SIGNATURE in the Signature Box below and the completed disclosure form can be scanned and submitted via email.
** By signing this form, you understand and agree that INVO can use the primary address you provide to Northwestern University in order to send you royalty payments if applicable.
NAME:

UNIVERSITY PHONE:

/

EMAIL:

CELL PHONE:

/

EMPLOYEE ID NUMBER:

HOME ADDRESS:
CITIZENSHIP:
SIGNATURE:
DEVELOPER 2 * Please sign in INK PEN, DIGITAL SIGNATURE (Example: /John Brown/), or ELECTRONIC SCANNED SIGNATURE in the Signature Box below and the completed disclosure form can be scanned and submitted via email.
** By signing this form, you understand and agree that INVO can use the primary address you provide to Northwestern University in order to send you royalty payments if applicable.
NAME:

UNIVERSITY PHONE:

/

EMAIL:

CELL PHONE:

/

EMPLOYEE ID NUMBER:

HOME ADDRESS:
CITIZENSHIP:
SIGNATURE:
DEVELOPER 3 * Please sign in INK PEN, DIGITAL SIGNATURE (Example: /John Brown/), or ELECTRONIC SCANNED SIGNATURE in the Signature Box below and the completed disclosure form can be scanned and submitted via email.
** By signing this form, you understand and agree that INVO can use the primary address you provide to Northwestern University in order to send you royalty payments if applicable.
NAME:

UNIVERSITY PHONE:

/

EMAIL:

CELL PHONE:

/ EMPLOYEE ID NUMBER:
HOME ADDRESS:
CITIZENSHIP:
SIGNATURE:
DEVELOPER 4 * Please sign in INK PEN, DIGITAL SIGNATURE (Example: /John Brown/), or ELECTRONIC SCANNED SIGNATURE in the Signature Box below and the completed disclosure form can be scanned and submitted via email.** By signing this form, you understand and agree that INVO can use the primary address you provide to Northwestern University in order to send you royalty payments if applicable.
NAME:

UNIVERSITY PHONE:

/

EMAIL:

CELL PHONE:

/

EMPLOYEE ID NUMBER:

HOME ADDRESS:
CITIZENSHIP:
SIGNATURE:

If there are additional Developers, please list their information here or on a separate sheet.

INVO | 1800 Sherman Ave, Suite 504, Evanston, IL 60201 | 847.491.3005 Page 1 of 6