Invention Disclosure Form
Email
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Organization
What is the best telephone number for us to use to reach you?
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Title of Invention
In which country was the invention created?
What is the approximate date of conception? When did you first come up with the invention? In addition, when did you write down details of your invention? How can you prove this date?
Who are the inventors? Please provide full names as desired in published patent application, and provide at least home city and home state for a provisional application; otherwise, full mailing address for each inventor.
What department or team is associated with the invention, if any?
Describe the innovation in general terms. What problem does your innovation solve?
How does it solve the problem? How do the different parts work together?
Describe in detail how your innovation works differently than products or services already available. How did others do it before? How did you or others do it before?
How does each new feature provide advantages over existing technology?
Is the invention related to or would be part of a current or future product? If so, which product?
Provide drawings, photos, charts, test results, etc. that show the workings of the innovation.
What Materials Have Been Used? What is or would be required to perform or use your innovation?
Is the any additional testing that would need to be done before you are sure that the innovation would work properly?
Yes
No
What is the “best” version or variation of your innovation if more than one version or option is available? Why?
What are the presently contemplated modifications, alterations, improvements, extensions of the invention?
How many hours of research was required to prove to yourself that the innovation would work properly?
When did you create a prototype, if any?
Have you told anyone about your innovation? If so, to whom and when? (For example, was the idea disclosed to colleagues? At a trade show?)
Have you published anything about the innovation (for example, in a journal article, in a handout at a demonstration)? If so, when and where?
Have you shown your innovation in public? If so, where and when?
Have you offered the innovation for sale, such as in a Statement of Work?
What is the closest technology known to others?
Provide optional references for any closely-related technologies.
Which companies or users would be interested in using or obtaining the innovation?
Will users of the innovation be using the innovation in 3 years? In 10 years? Explain why or why not.
I hereby affirm that all of the above information is correct to the best of my knowledge (please type your name below).