INVENTION DISCLOSURE REPORT
(Attach additional sheets as appropriate)
In order to afford maximum protection and to comply with the requirements of the university policy and federal contracts and grants, it is important that inventions or discoveries that may be patentable be reported to the Vice Provost for Research at the earliest possible date.
PLEASE COMPLY WITH THE FOLLOWING DIRECTIONS IN COMPLETING THIS FORM:
(A) Fill out in duplicate and retain one copy as a permanent record.
(B) Use supplemental sheets if necessary to amplify this information.
(C) If you cannot answer any questions at this time, please so indicate.
(D) Submit completed form and any attachments to
Contact Barbara Kooiman if you have any questions (, phone 248.370.2762)
1. Full name, address, and phone of the inventor or inventors.
2. Invention Title.
3. Concise description of invention: Attach a description of the invention, with photographs, drawings, sketches, or any other descriptive material. Description should be sufficiently detailed to enable one skilled in the art to understand and reproduce the invention and should include the construction, the principles involved, the details of operation, and alternative methods of construction or operation. Be certain the description covers the following points:
(a) Problem to be solved, or purpose of invention
(b) How invention solves problem
(c) Similar inventions in current use, or old manner of performing the function of the invention
(d) Disadvantages of old means
(e) Degree of development
Include description of and/or inclusion of supporting evidence such as copy of laboratory notes, computer programs, drawings, etc. (Attach data)
4. Date and location invention was first conceived.
5. Date of publication(s) or presentations: where published – include meetings, presentations, journals, etc. (include publication copies if available)
6. Date and to whom invention has been disclosed.
7. Date of the first sketch or model.
8. Names and addresses of other persons who participated or contributed to this invention.
9. Has the invention been tested? If so, provide details including date of first test and results recorded.
10. Has the invention been used? If so, was the use primarily experimental or was it in course of business?
11. Did a sponsored project contribute to this invention? If so, list funding agency, title of project, grant number, and university grant fund number for each source.
12. Contribution from the University to the invention (include funds, space, personnel, and facilities):
INVENTION DISCLOSURE FORM, continued
Page 2 of 2
Primary Inventor
Date
13. Are there are any prior patents or patent applications made to protect this invention? If so, please list Serial Number and filing date (include copies of applications if available).
14. Does the inventor know of any patents or publications by “others” that are similar to this invention? If so, please list patent publication Serial Number and attach copies of non-patent publications.
15. What particular features of this invention are novel? How does the technology differ from present technology?
16. Describe the commercial application of the invention, potential markets and any specific industry or business contact persons who may be interested in this invention.
17. PLEASE ATTACH AN ABSTRACT OF THE INVENTION. The abstract may be shared to promote the invention, and therefore, should be no longer than a typewritten page and not contain confidential information.
18. MAJOR USE OR OTHER APPLICATIONS OF INVENTION. If specific commercial possibilities or companies are known, please include names and addresses on a separate page.
19. MARK APPROPRIATE CATEGORY:
____Biomedical: biological materials, medical-dental products or devices for diagnosis, therapy
____Chemicals: methods, processes, compounds, catalysts
____Computers & Software: methods, programs, tool, networks
____Devices: engineering, analytical, imaging devices
____Materials: ceramics, metals, methods of production, superconductors
____Other:______
20. Are you willing to assist in the commercialization of your invention?
This disclosure is made to Oakland University under the University Patent Policy in effect at this time.
Signature of Inventor(s) Date
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Revised August 2013