/ University of Massachusetts Amherst
101 University Drive, Suite B6, Amherst, MA 01002
Phone: 413-545-3606
Email:
Web: www.umass.edu/tto

CONFIDENTIAL

Invention Disclosure Form

The beginning of a conversation

·  This questionnaire is an easy way to let us know you made an invention and give us basic information. You don’t need to convince us of anything!

·  We will contact you very soon after we receive your questionnaire to ask any further questions we may have, and to explain the next steps.

·  You don’t even have to fill out the questionnaire! Just give us a call at 413-545-3606, and we will come over and fill out the questionnaire for you.

·  If you are unsure how to answer a question, just leave it blank and we’ll talk to you about it later. Or, give us a call and we’ll help you answer it.

·  Feel free to add space after a question if your answer is longer.

·  If you are not finished completing this form in 1 hour, you are probably going farther than is needed at this point. Please call us and we will help.

·  We will keep you informed as we evaluate patentability and market potential, and we will discuss any decisions with you before they are made.

·  If we file a patent application, our patent attorney will speak to you directly to learn about the invention in more detail.

·  You can send us the completed form in hard copy, or scan and email it to us.

·  We want inventing to be exciting, not tedious! At the end are a few supplemental questions to help us make sure this is an easy process.

The TTO is a Unit of the Office of Research & Engagement

Phone 413-545-5270 Web: www.umass.edu/research/

UMA #______Tech ID: ______CONFIDENTIAL

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The TTO is a Unit of the Office of Research & Engagement

Phone 413-545-5270 Web: www.umass.edu/research/

UM# ______Tech ID: ______CONFIDENTIAL

Invention Disclosure Form

Short title of the Invention:

Inventor(s) / Phone / Email / Department (If not UMA, list employer
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1.  Please provide a brief description of the invention.

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CONFIDENTIAL

2.  If you have one, please attach a manuscript or other document that describes the invention in more detail. (It’s OK if you don’t, we will ask you for what we need.)

3.  How does the invention improve upon what was previously known?

4.  What products or services are made possible by the invention? (We will evaluate this further.)

5.  Do you know of any existing products or services these might compete with? (No need to investigate, we will explore this.)

6.  Please list any publications or patents you know of that might be relevant to this invention. (No need to investigate, we will do patent and literature searches.)

7.  Do you know of any companies that might be interested in this invention? (If not it’s OK, we will research this.)

8.  Do you know anyone at any of these companies? (If not it’s OK, we will find the right people.)

9.  Are you continuing to do research on this invention? If so, please describe briefly.

10.  Have you presented or published the invention, or the research that led to it?

11.  Do you have any plans to present or publish in the next 30 days? If so, when?

12.  Has the research that led to the invention been sponsored or funded by industry, or funded by a grant(s) from a government agency or private foundation? Yes or No

If yes, please provide TTO with information on all funding sources for research that resulted in this invention.

INDUSTRY OR FOUNDATION SPONSOR / GRANT # / CONTRACT #

13.  In this research did you use any materials provided by another institution or company?

14.  It isn’t practical to consult with all of you. Who should be our primary point of contact?

15.  Is there anything else you think we should know?

16.  Please sign below, to indicate (i) you are the original inventors, (ii) you will help us in the patenting process, and (iii) you will sign documents that require your signatures.

Name Signature Date

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Supplemental questions to help us improve the disclosure process:

1.  About how long did it take you to complete this disclosure?

2.  Were there any questions that were unclear? If so, which ones?

3.  Are there any questions that could be stated in a better way? If so, which ones and how?

4.  On a scale of 1 to 10, with 1 being the easiest, how difficult was it to complete this form?

5.  Please provide us with any other suggestions or comments you may have.

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The TTO is a Unit of the Office of Research & Engagement

Phone 413-545-5270 Web: www.umass.edu/research/