Life Sciences Discovery Fund –Intellectual Property Roster

A sample intellectual property roster and instructions appear below; the applicant must complete the blank roster that appears below the sample roster. Do not include the sample roster or the instructions in your PDF documents as part of your final proposal. If you have questions, please contact LSDF at .

  1. List all items of intellectual property (including issued patents, patent applications, trademarks, trade names, copyrights, service marks, or other [describe]) owned or licensed by the applicant organization. If more rows are needed, use additional sheet(s).
  2. For each item of intellectual property, provide the reference number, the type of intellectual property, the filing/issue dates, the subject matter, and(for issued patents and patent applications)a summary of key independent claims.
  3. In the Applicant Organization Ownership/Licensing Status column, indicate whether the applicant organization owns the item of intellectual property (listing co-owners as applicable). If the organization does not own the intellectual property, describe licensing or other agreements that provide the applicant organization with access to the intellectual property for development and commercialization of the product or service that is the subject of the LSDF grant.

LSDF will hold the information in this roster confidential in accordance with its confidentiality policy ( subject to the public disclosure laws of the state of Washington (

Life Sciences Discovery Fund Intellectual Property Roster

PI Name: / SAMPLE INTELLECTUAL PROPERTY ROSTER – DO NOT INCLUDE THIS TABLE IN THE APPLICATION
Proposal Title: / This sample table provides an example of how to complete this form. Do not include this sample table in the proposal;a blank table appears below. If you have further questions, please contact LSDF at .
Reference Number / Type of Intellectual Property / Year of Filing/Issue / Subject Matter / Summary of Key Independent Claims (for Issued Patents and Patent Applications) / Applicant Organization Ownership/Licensing Status (Describe)
X,XXX,XXX / Issued patent (US) / Filed 2003, Issued 2009 / Gene signatures to predict breast cancer metastasis and prognosis / Method of classifying human breast cancer using a transcriptional expression profile comprising a dataset of expression information for at least 40 genes selected from the XYZ gene family. / Fully owned by applicant organization
XX/XXXXXX / Patent application (US) / Filed 2010 / Breast cancer metastasis gene ABCDEF / Isolated nucleic acid and amino acid sequences and methods of detection. / Exclusive worldwide license for all fields of use from ABC University
N/A / Copyright / 2008 / Computer software for stratifying risk of human breast cancer metastasis based on gene expression profiles / N/A / Jointly owned by applicant organization and ABC University
XXXXXXXX / Trademark / 2011 / “GenTest” - a mark associated with genetic testing and analysis to predict breast cancer metastasis and prognosis / N/A / Fully owned by applicant organization

Life Sciences Discovery Fund – Intellectual Property Roster

PI Name:
Proposal Title:
Reference Number / Type of Intellectual Property / Year of Filing/Issue / Subject Matter / Summary of Independent Claims (for Issued Patents and Patent Applications) / Applicant Organization Ownership/Licensing Status (Describe)

Life Sciences Discovery Fund Intellectual Property Roster