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					No. Tecnología
(Para ser llenado por el el Programa INVITE)

Application Form
Please fill out the following in English and return it via email to dkidwell@icc.utexas.edu

NAME OF TECHNICAL INNOVATION:
(A descriptive name that explains what it is)

CONTACT INFORMATION:
Full Name of the Principle investigator/inventor contact; Company: E-Mail: Telephone: Fax: Mailing Address:

Administrative Contact: Company: E-Mail: Telephone: Fax: Mailing Address:

TECHNICAL DESCRIPTION:
1. ¿What does the technology do?
(En lenguaje NO científico o técnico por favor describa “que hace” la tecnología -NO como funciona-. 100 palabras o menos.)

2. ¿Where was the innovation invented/developed?

3. ¿What was the problem that this technology was created to solve? (En lenguaje NO científico o técnico
por favor describa “para que ”fue creada la tecnología, cual es el (los) problema(s) que resuelve. Máximo 5 renglones)

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4. ¿How does this technology address the problem? (Por favor NO divulge en su respuesta información
confidencial o de propiedad intelectual. Máximo 5 renglones)

5. ¿To your knowledge, do similar solutions exist anywhere else in the world? (Yes or No) 6. If you answered "YES" to Question 5 above, please explain why it was decided to develop this innovation instead of using an existing solution. (Si su respuesta fue "NO" favor de pasar a la pregunta 8)

7. What specific improvements or benefits are available in this innovation that are not available in other existing solutions? Why is this innovation better than the existing solutions? How much better is it (%, multiple or other measure)? 8. Why did the inventor create this technology?

9.In what ways could this innovation be used? Which industries might use it?

10. Who is the primary customer for your invention? Who would pay money to use it?

11. Who is the primary user of your technology? Who needs your technology?

INTELLECTUAL PROPERTY STATUS
12. Who owns the intellectual property?
(Liste a todos los dueños y su % propiedad/ownership)

13. What IP protection does the technology currently have? (Use an X) Patents Porduct (*) Utility Model (*) Industrial Design (*) Copyrights Trade Secrets Don’t know None
* Please answer questions 14–18 below

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14. Has this innovation been granted any patents in its originating country? (Use an X) No patents have been granted A patent is pending A patent has been granted 15.Please list the patents that have been granted or are pending for this innovation: Patent Name Patent Number Patent File/Grant Date Patent Name Patent Number Patent File/Grant Date Patent Name Patent Number Patent File/Grant Date 16. Have PCT applications been filed?(Yes or No) 17. Please list the patents that have been granted by other nations or patent granting agencies: Patent Name Patent Number Granting Nation/Agency Patent Grant Date Patent Name Patent Number Granting Nation/Agency Patent Grant Date Patent Name Patent Number Granting Nation/Agency Patent Grant Date

DEVELOPMENT STATUS
18. What is the current status of this innovation? (Choose with an X the single best answer) Concept only Prototypes exist Successful laboratory model/test Full-scale prototype In field testing or trials Fully implemented / in use 19. How many calendar months do you estimate will be required before this innovation is completely developed and ready for the market? (Choose with an X the single best answer) None–in active use now 1-3 months
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4-6 months 7-12 months 13-18 months More than 18 months 20. What is the total cost (including manpower, equipment and all other resources) required to complete market-ready development of this innovation? (Choose with an X the single best answer) None-in active use now $100,000 USD or less $250,000 USD or less $500,000 USD or less $1,000,000 USD or less More than $1,000,000 USD Don´t know 21. What is the availability of the inventor(s) to support the development and commercialization or this innovation for tasks such as refinements to the technology, troubleshooting and problem solving? (Choose with
an X the single best answer)

Inventor(s) is/are readily available full-time Inventor(s) is/are readily available half-time Inventor(s) has/have limited availability Inventor(s) is/are not available at all 22. What level of involvement would the inventor like to have in commercialization of the technology? Inventor(s) would prefer to focus primarily on research Inventor(s) would prefer to participate in a decision–making role. Inventor(s) is prepared to leave current employment to pursue commercialization. Inventor(s) is NOT prepared to leave current employment to pursue commercialization.

ADDITIONAL INFORMATION
A) You may attach 2-3 drawings or other documents B) Is there anything else you would like us to know regarding this technology? (Please limit your
response to 100 words or less.)

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