LSU Health Shreveport

LSUHSC-S-2019-_____

LSU Health Shreveport

TECHNOLOGY TRANSFER

DISCLOSURE PACKET

Office for Sponsored Programs

and Technology Transfer

File No. LSUHSC-S-2019-______

CONFIDENTIAL

TECHNOLOGY DISCLOSURE

OFFICE FOR SPONSORED PROGRAMS & TECHNOLOGY TRANSFER

LSUHSC-SHREVEPORT

I. Introduction

This Confidential Invention Disclosure Form is used to disclose an LSUHSC-S (University) invention as required under LSUSystemPolicies PM-11 Outside Employment of University Employees, PM-16 Technology Transfer, and PM-64 Intellectual Property - Distribution of Royalties and Other Matters. An invention disclosure should be made when something new and useful has been conceived or developed, or when unusual, unexpected, or unobvious research results have been achieved and can be utilized. An invention includes any discovery, new and useful process, composition of matter, article of manufacture, know-how, design, model, technological development, biological material, strain, variety, culture of any organism, or portion, modification, translation, or extension of these items, and any mark used in connection with these items.

Please note that this information should be submitted prior to publication as public disclosure of the invention places severe limitations on available patent protection. Non-confidential disclosure of an invention (to people outside the University) may cause a loss of rights which prevents patent protection of the disclosed invention. Thus, to ensure the possibility of worldwide patent protection, it is important that invention disclosures be submitted for timely review so that a U.S. patent application can be filed before public disclosure occurs.

II.DISCLOSURE OF INVENTION

A.TITLE: ______

(Brief, but comprehensive, technically accurate, and descriptive; 10 words or less)

B.CONCISE DESCRIPTION OF THE INVENTION

1.The disclosure should enable someone having knowledge of the field to understand the technical merits of the invention, its usefulness and possible practice applications. Include essential elements (features, concepts, or new results of the invention, whichever is most applicable), their relationship to one another, and their mode of operation. Identify the elements that are considered novel. (Attach additional sheets as necessary.) Please feel free to use the attached LSUHSC-S research template that can be used to prepare the description of your technology

______

2.Please list KEYWORDS that would help someone searching for this technology to locate it easily. ______

______

3.If the invention is an apparatus or system, attach drawings or a sketch and indicate if it has ever been built or tested.Use additional pages, attach drawings, manuscripts, papers, or other supporting material to facilitate understanding the invention. Attach any data which shows that the invention works.

C.PRODUCTS: Describe the most likely products, services or commercial processes or other applications
that could result from this invention.

______

D.COMPETITIVE ADVANTAGES

List existing products, services or processes, and describe how the subject invention willprovide or contribute to superior advantages or unique features (e.g., what could it do to help apotential customer: lower expenses, increase productivity, efficiency or accuracy, minimize risk,simplify a process, overcome a defect, increase revenue, promote safety?)

______

III.POTENTIAL LICENSEES / PARTNERS/COMPETITORS

A.If you are aware of companies or a research sponsor who will be a potential license for this invention, please indicate that company (with specific individual and phone number) in the space below:

______

SUPPLIERS

What companies are the major suppliers for products or services that could or will compete with theInvention?

______

C.Have you communicated with any industry representative regarding your invention?

YES ______NO ______

If yes, please provide the following information for each company:

Was such a disclosure made under a confidentiality agreement? YES _____ NO _____

Date of Disclosure______

Company______

Address______

City/State/Zip______

Telephone Number______

Individual Contact______

Official Title______

IV.PUBLIC DISCLOSURE / PUBLICATION PLANS

Public disclosure includes abstracts and presentations at scientific meetings (including poster sessions), public seminars, shelving of theses, publications, disclosure to others outside of the University who have not signed a confidentiality agreement, and the use, sale, or offer of sale of the invention. Identify the first dates and circumstances of any such disclosures. Also, indicate your future disclosure or publication plans, and NOTIFY the Office for Sponsored Programs before the invention becomes publicly disclosed or published in the future (whether by plan or inadvertently).

A. Which of the following have you done or do you intend to do?

YESNODATE

1.Publish______

2.Oral Presentation______

3.Poster Session______

4.Disclose to Industry Rep.______

5.Other Public Dissemination______

Please attach anypublished technical material such as patents, commercial literature, or scientific articlesrelating to the invention.

V.FINANCIAL SUPPORT / CONTRACT IDENTIFICATION

The primary purpose of this section is to identify any specific grant or contract number(s) (not the account number) and the external sponsors (governmental agencies, industrial sponsors, private agencies, or others) which provided support used to defray costs related to the research from which the invention resulted. This information is required by federal law and is needed to determine whether this invention is subject to any commitments or restrictions arising from the terms of sponsorship. This includes funding for research assistants, post docs, or any other persons working on this project. Be sure to include other research centers, consortiums and institutions.

A. Please provide the following information regarding any contract and grant support of the invention process. (The following information must be provided for EACH contract or grant that supported the invention process; attach additional sheets if necessary.)

Name ______

Grant/Contract # ______

Address ______

City, State, Zip______

P.I. Name ______

Grant/Contract Title______

B. Did any of the contributors use any instrument(s) biological, chemical or physical material(s) or substance(s) obtained from others to create this invention? YES ______NO ______

If YES, did a Materials Transfer Agreement or other document accompany the transfer?

YES _____NO _____Please list or attach any such agreements.

C. Did you or any of the co-contributors submit a PM-11 Outside Employment of University Employees form? YES _____ NO _____

D. Did any of the contributors have academic appointments or employment contracts with organizations other than the University during the course of this work? (e.g. V.A., Christus Schumpert, Willis-Knighton, LSUS, ULM, etc.)

YES _____NO _____

If yes, where? ______

EXECUTION BY INVENTORS: By signing below, you affirm that you are not under any obligation to assign rights in this technology to any other party (e.g., to an employer for whom you worked before your employment at LSUHSC-S began).

You further agree to assign and do hereby assign to LSU all of your right, title, and interest in and to this invention and all other LSU Intellectual Property (as defined in Part II, Chapter VII of LSU’s Bylaws & Regulations), in accordance with LSU’s Bylaws & Regulations and as required by your employment with LSU

(NOTE: this affirmation does not apply to non-LSUHSC-S inventors). If the “Contribution %” fields have been completed above, then by signing below you are also agreeing to an irrevocable allocation of the inventors’ share of royalties accordingly. LSUHSC-S may require you to sign an independent assignment letter.

You further agree that in accordance with Chapter VII of the LSU’s Bylaws & Regulations, should this technology be licensed to an outside party and royalty payments are received by LSUHSC-S, you, as an inventor, do hereby agree to receive your royalty payments within 30-60 days after LSUHSC-S has received the funds from the licensee. This timeframe will allow LSUHSC-S to (1) confirm the collection of the funds, (2) request and prepare your payment voucher, and (3) to mail the check to your personal address, as outlined below.

VI.IDENTIFICATION AND SIGNATUREOF INVENTORS AND/OR CONTRIBUTOR(S)

List below all persons who are believed to have contributed to the conception or creative reduction to practice of this invention. Please provide addresses and phone numbers where they may be contacted. Please make additional copies for researcher information as necessary.

Inventor #1

Name: Click here to enter text. / Title: Click here to enter text. / Citizenship: Click here to enter text.
LSUHSC Address: 1501 Kings Highway, Shreveport, LA 71103
Department: Click here to enter text. / Contribution %: Click here to enter text.
Work Phone: Click here to enter text. / Work Email: Click here to enter text. / Other Email: Click here to enter text.
Home Address: Click here to enter text. Information necessary for royalty distribution.
Signature: Date:

Inventor #2

Name: Click here to enter text. / Title:Click here to enter text. / Citizenship: Click here to enter text.
LSUHSC Address: 1501 Kings Highway, Shreveport, LA 71103
Department: Click here to enter text. / Contribution %: Click here to enter text.
Work Phone: Click here to enter text. / Work Email: Click here to enter text. / Other Email: Click here to enter text.
Home Address: Click here to enter text. Information necessary for royalty distribution.
Signature: Date:

Inventor #3

Name: Click here to enter text. / Title:Click here to enter text. / Citizenship: Click here to enter text.
LSUHSC Address:1501 Kings Highway, Shreveport, LA 71103
Department: Click here to enter text. / Contribution %: Click here to enter text.
Work Phone: Click here to enter text. / Work Email: Click here to enter text. / Other Email:Click here to enter text.
Home Address: Click here to enter text. Information necessary for royalty distribution.
Signature: Date:

Inventor #4

Note: The foregoing list should include names of all persons who may qualify as legal inventors. Inventorship is a matter of law and is determined with assistance of the attorney of record.

(IF MORE THAN FOUR INVENTORS, PLEASE ADD ADDITIONAL SHEETS)

VII.DISTRIBUTION to Office for Sponsored Programs and Tech Transfer

Email this completed disclosure and ALL attachments to Julia Knight, Tech Transfer Coordinator ( ) and the Tech Transfer email: Please send the original signed forms to the OSPTT. BRI First Floor, F1-50. If you have any questions, Julia’s phone number is (318) 675-4125.

LSUHSC-S Technology Transfer

Patent Application Sample Template

[1][TITLE OF THE INVENTION]

[2]CROSS REFERENCE TO RELATED APPLICATIONS/PRIORITY (if applicable)

[3]STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT (if applicable)

[4]REFERENCE TO A MICROFICHE APPENDIX (if applicable)

-BACKGROUND OF THE INVENTION

[5] (describe background in as few words as reasonably possible. There are 2 parts to the background, the field of the invention and the description of related or “prior art”. The prior art part is where you need to be careful. Basically state what are the problems the invention tries to solve and what is wrong with the approach taken by the prior art. Any document you state is prior art becomes automatic prior art against your patent, even if it wouldn’t otherwise – and you cannot take it back. This is why you should NEVER use the term PRIOR ART in the description without a good reason)

[6]FIELD OF THE INVENTION

[7] The present invention relates to… (1-2 sentence brief description)

[8]DESCRIPTION OF RELATED ART

[9](1-2 paragraphs giving background. What problem is the invention trying to solve and what is wrong with the current methods/devices used to solve the problem. Why there is a need for the invention?)

[10]SUMMARY OF THE INVENTION

[11] Wherefore, it is an object of the present invention to overcome the above mentioned shortcomings and drawbacks associated with the prior art.

[12] Another object of the present invention is to (describe a first specific aspect of the invention).

[13] A further object of the invention is (describe a second specific aspect of the invention)

[14] A still further object of the invention is (describe a third specific aspect of the invention…)

[15]BRIEF DESCRIPTION OF THE DRAWINGS

[16] The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate various uses of the invention and together with the general description of the invention given above and the detailed description of the drawings given below, serve to explain the principles of the invention. It is to be appreciated that the accompanying drawings are not necessarily to scale since the emphasis is instead placed on illustrating the principles of the invention. The invention will now be described, by way of example, with reference to the accompanying drawings in which:

[17] Fig. 1 is a (and describe each of n drawings; preferably in less than a sentence a piece, and what is it of in relation to the invention, the drawings can be graphs or tables of experimental results, HPLC graphs, microscopy photos, chemical structures, and flow charts of a method, just for example.);

[18] Fig. 2 is a …;

[19] Fig. 3 is a …;.

[20] Fig. “n-1” is a …; and

[21] Fig. “n” is a …

[22]DETAILED DESCRIPTION OF THE PREFERRED TECHNOLOGY AND EXAMPLES

[23] The present invention will be understood by reference to the following detailed description, which should be read in conjunction with the appended drawings. It is to be appreciated that the following detailed description of various uses of the technology is by way of example only and is not meant to limit, in any way, the scope of the present invention.

[24] Turning now to Fig. 1, a brief description concerning the various components of the present invention will now be briefly discussed. As can be seen in this use of thetechnology… (and spend a few pages describing the invention with frequent, and preferably sequential, reference to the drawings. You point out in the description how and why you are better than what has come before. This is also the place where you will describe your experiments (the foundation / proof that what you claim has been reduced to practice to some extent), include chemical structures for your various chemicals, and list various possible TECHNOLOGYs, combinations, dosage ranges, different functional groups, integrations of other technologies, …)

[25]Turning next to Fig. 2, another aspect of the invention is shown…(continuing to use Figures to explain invention)

[26]As can be seen in Fig. 3, a second use of the technology is shown…( continuing to use Figures to explain invention)

[27]Turning finally to Fig. “n”…(Using the figures as a general roadmap for describing the invention is a common approach that keeps the application organized and on point)

[28] (Will end Detailed Description with this paragraph) While various uses and examples of the present invention have been described in detail, it is apparent that various modifications and alterations of those uses will occur to and be readily apparent to those skilled in the art. However, it is to be expressly understood that such modifications and alterations are within the scope and spirit of the present invention, as set forth in the appended claims. Further, the invention(s) described herein is capable of other uses and of being practiced or of being carried out in various other related ways. In addition, it is to be understood that the phraseology and terminology used herein is for the purpose of description and should not be regarded as limiting. The use of "including," "comprising," or "having," and variations thereof herein, is meant to encompass the items listed thereafter and equivalents thereof as well as additional items while only the terms “consisting of” and “consisting only of” are to be construed in a limitative sense.

CLAIMS (some examples…)

Wherefore, I/we claim:

1. A method for treating cancer comprising:

administering ______(chemical formula or name) compound to an animal;

wherein the cancer is selected from the group consisting of (e.g., breast cancer, kidney cancer, colon cancer, rectal cancer, ovarian cancer, stomach cancer, uterine cancer, carcinoma in situ, and leukemia…)

2 A compound comprising

______(chemical formula or name); where the R1 is selected from the group consisting of….

(Although claims are not required for provisional applications, it is good practice have at least one so that you can gauge if you have enough material disclosed in the specification to support a claim. Don’t worry about the claim if you don’t know )

ABSTRACT

(Unlike a science paper abstract, normally the patent abstract is just whatever claim 1 is put into a sentence format)

CONFIDENTIAL