Документ взят из кэша поисковой машины. Адрес оригинального документа : http://www.innovation.msu.ru/english/reportofinvention.doc Дата изменения: Thu Oct 27 17:42:05 2005 Дата индексирования: Mon Oct 1 20:52:23 2012 Кодировка:

Submission Instructions
Please read all instructions before completing the form.


Submission instructions

Send an original, signed form to:

TEC Edmonton

University of Alberta

4000 Research Transition Facility (RTF)

8308 - 114 Street

Edmonton, AB T6G 2E1

For assistance or more information

If you require additional information about this form, your obligation to
disclose inventions, or if your would like to consult with our staff before
completing this form, contact TEC Edmonton's Technology Transfer team
member assigned to your faculty (visit www.TECedmonton.com and select
"Contact Us").




| |
|Title of Invention (non-confidential) |
|Title: | |TEC Edmonton file |
| | |number: |
| |
|Principal Inventor (Contact Person) |
|Name: | |Telephone: |
| | |- ext. |
|Surname Given Name(s) |
|E-mail: | |Citizenship: |
|Department: | |Faculty: |
|Department address: |
|Room number and building Postal Code |
|Co-Inventor (1) |
|Name: | |Telephone: |
| | |- ext. |
|Surname Given Name(s) |
|E-mail: | |Citizenship: |
|Department: | |Faculty: |
|Department address: |
|Room number and building Postal Code |
|Co-Inventor (2) |
|Please attach a separate sheet if there are more co-inventors involved. |
|Name: | |Telephone: |
| | |- ext. |
|Surname Given Name(s) |
|E-mail: | |Citizenship: |
|Department: | |Faculty: |
|Department address: |
|Room number and building Postal Code |


One of our technology transfer representatives can help you complete this
form. Please contact us for an appointment.

|For TEC Edmonton use only Sector: | Life sciences |
| |Physical sciences |
| |Hardware/software |
| |Instructional |
| |technology |
|TTG representative handling file: | | |
|49 | | |
|Name Phone |



|Brief Description |
|Is the invention a new process; new plant cultivar or germplasm; |
|microorganisms; composition of matter; a new device or product(s); a new use |
|for or an improvement to an existing product or process; copyrightable |
|software; an industrial design; or unique microelectronic topography? |
|(Although the rest of this document will be treated as confidential, this |
|brief description will be used for public database listing and therefore |
|should contain only non-confidential information - 30 words maximum). |
|Enclose sketches, photographs and other materials to illustrate the |
|description. |
| |
|Commercial Feasibility |
|Please identify and expand on the novel and advantageous features of the |
|technology. How does it differ from existing technology? What problems does it|
|solve? (If you require additional space, it is available in section 9.) |
|List the potential products you envision resulting from this invention, and |
|whether you think these products could be developed in the near term (less |
|than 2 years) or the long term (more than 2 years). |
|If not covered above, please: |
|Describe alternate technologies that accomplish the same purpose as this |
|invention. |
|List companies and products currently on the market that make use of these |
|alternate technologies. |
| |
| |
|Who would use the technology? |
|Has any commercial interest been shown at this stage? |
| No Yes |( Name companies and specific persons if possible. |
| | |
|6 | |
|Do you know of any other qualified firms? |
| No Yes |( Please list. |
| | |
|6 | |
| |
|Patentability |
|Proof of Invention: |
|Are written and dated laboratory records and data available? |
| No Yes |( Give reference and physical location, but do not enclose. |
| | |
|6 | |
| |
|Reduction to Practice: |
|Has the apparatus, product or process been made or tested? No Yes |
| |
|Publication/Disclosure: |
|Has the invention been published or submitted for publication? |
| No Yes |( Please list with publication dates, and attach copies. Include |
| |manuscripts, news releases, feature articles and items for |
|6 |internal publications. |
| |Date: Publication: |
| | |
| | |
| | |
| | |
| | |
| | |
|Has this invention been described (in writing or verbally) to anyone outside |
|your U of A colleagues? |
| No Yes |( Please provide date, place and circumstances. |
| | |
|6 | |
|Is the invention the subject of a thesis? |
| No Yes |( Please provide date of defence or anticipated date of defence. |
| | |
|6 | |
|Is there, within the next six months, a meeting of a learned society, deadline|
|or publication of a scientific journal at which you intend to disclose the |
|invention? |
| No Yes |( When? Where? |
| | |
|6 | |
| |


|Prior Art: |
|Has a recent patent and literature search been performed? |
| No Yes |( List any patents or publications describing the invention or |
| |aspects of the invention: |
|6 | |
| |( Name of database search completed: |
|Does the inventor know of any other related patents or publications? |
| No Yes |( Please list. |
| | |
|6 | |
|List any key competing research groups currently engaged in research and |
|development in this area. |
| |
|Third Party Rights: |
|How was the work that led to the invention funded? |
|Funding agencies/companies: Year(s) of funding: |
| |
| |
| |
|Were any Networks of Centres of Excellence funds involved in the research? |
| No Yes |( Which Network? |
| | |
|6 | |
|Was the invention created using a material provided by a third party? |
| No Yes |( Please specify: |
| | |
|6 | |
|Was the invention created using confidential information of a third party? |
| No Yes |(Please specify: |
| | |
|6 | |
| |


|Development Stage |
|Is additional research needed or underway to complete development and testing |
|of the invention? |
| No Yes |( Please describe briefly. |
| | |
|6 | |
| |( Are funds available to do this? |
| |No Yes |( Please outline funding: |
| |6 | |
|What disadvantages or limitations need to be addressed by future research? |
|Is there further research planned or underway to address these issues? No |
|Yes |
| |
|Freedom of Information and Protection of Privacy Act |
|The Inventor(s) acknowledge that all records prepared by the University in |
|dealing with the within matter are in the custody and control of the |
|University. The University is or will be subject to the access and privacy |
|provisions of the Freedom of Information and Protection of Privacy Act |
|(Alberta) which creates a right of access to records under the custody and |
|control of public bodies subject to specific, limited exceptions. |
|The records produced based on this Document contains information that would |
|reveal trade secrets of the Inventor(s) or commercial, financial, scientific |
|or technical information of the Inventor(s) that is supplied in confidence, |
|the disclosure of which could reasonably be expected to either: |
|harm significantly the competitive position or interfere significantly with |
|the negotiating position of the Inventor(s) or their agent(s); or |
|result in similar information no longer being supplied to the University when |
|it is in the public interest that similar information continue to be supplied;|
|or |
|result in undue financial loss to the Inventor(s). |
|Accordingly, except as required by law or as otherwise permitted pursuant to |
|the terms of this Document, neither the University nor the Inventor(s) will |
|disclose the contents of this Document or the foregoing records other than, |
|for the purpose of implementation or enforcement of the same; or |
|a general statement on the parties to the Document and the Title of the |
|Technology, either party being entitled to publish that information. |
|Additional Information |
|Please use the space below, and additional sheets, to provide information to |
|facilitate the protection and commercialization of this technology. |
| |




|Commercialization Options for Inventors |
|The University of Alberta Patent Policy obligates all faculty and students to |
|report all inventions (article 7.2) and provides the inventor with the choice |
|(articles 8 and 9) of commercializing their invention through the TEC Edmonton|
|office or independently. For additional information on the Patent Policy |
|please contact TEC Edmonton. |
|Please indicate whether you wish to proceed with commercialization independent|
|of the University or through TEC Edmonton by checking AND signing either |
|OPTION A or OPTION B. |
| A|( Via the Research Services Office. Assignment of Invention to the |
| |University of Alberta |
| |For valuable consideration we report and assign all of our interest in and|
| |to the invention herein described together with any future improvements to|
| |The University of Alberta. |
| |Inventor's signature(s) (if selecting option A, | |Date: |
| |all inventors MUST sign here ONLY). | | |
| |1. | | |
| |Print Name Signature |
| | | |Date: |
| |2. | | |
| |Print Name Signature |
| | | |Date: |
| |3. | | |
| |Print Name Signature |
| |
| B |( Independent of the University of Alberta. |
| |We hereby report the above described to the University of Alberta. |
| |Inventor's signature(s) (if selecting option B, | |Date: |
| |all inventors MUST sign here ONLY). | | |
| |1. | | |
| |Print Name Signature |
| | | |Date: |
| |2. | | |
| |Print Name Signature |
| | | |Date: |
| |3. | | |
| |Print Name Signature |
|Signatures of University Officials |
|Upon the selection of either choice A or choice B, through the signature(s) |
|below, the Department Chair(s), and the Associate Dean (Research), |
|acknowledges an awareness of, and understand, this report of invention. |
|Department (1) Chair: | |Date: |
|Print Name Signature |
|Department (2) Chair: | |Date: |
|Print Name Signature |
|Associate Dean (Research): | |Date: |
|Print Name Signature |
|Institutional Representative for the UofA: | |Date: |
|Print Name Signature |