Patent Assistance Information Form Company Name Contact Name Address __________________________________________ __________________________________________ __________________________________________ __________________________________________ Email Phone Number __________________________________________ __________________________________________
The information provided in this form will be used by Michigan Tech Enterprise Corporation (MTEC) to explain the appropriate steps for a patent application. MTEC has advised that confidential information about an invention should not be disclosed prior to meeting with a patent attorney. Inventor/Applicant Signature _________________________________ Date _________________
Patent Assistance Information Form
1.Does the invention fit any of the following Michigan Tri-Corridor Technical Fields? Yes/No
Life sciences: Pharmaceuticals, Medical devices, Instrumentation, Diagnostics, Biotechnology research and ancillary services Advanced automotive processes and technologies: Improve safety, vehicle performance, product quality and durability; Promote advanced power train and alternative energy technologies and environmentally conscious solutions; Reduce costs Homeland security preparedness to threats to national protection: Prevention – Biometrics, vaccines, intelligent systems, cargo screening systems; Detection – Bio and radiation sensors, training; Reaction – EMS equipment, communications, computer modeling; Recovery – Bioremediation, decontamination
Describe: ________________________________________________ ________________________________________________________ 2. Are detailed notes and drawings available for the invention that includes witness signatures and dates? Yes/No 3. Has a provisional patent been obtained? Yes, Date: _______ /No 4. When, and in what manner, were any disclosures or demonstrations made about the invention? ________________________________________________________ ________________________________________________________ 5. Does a working model exist? Yes, as of date: ________ /No 6. What prior art related to the invention has been identified by searching the USPTO website or other source? Provide details. ________________________________________________________ ________________________________________________________ 7. Was the invention conceived while working under any contract? Yes, provide details. /No ________________________________________________________ ________________________________________________________ Confidential Michigan Tech Enterprise Corporation Page 2
Patent Assistance Information Form
8. Does a source of funding exist to complete the patent process, estimated up to $15,000 for a U.S. patent? Yes/No 9. Has a market evaluation been conducted for the invention? Yes, provide details. /No ________________________________________________________ ________________________________________________________ 10. What stage/type of patent assistance is desired? Patent application procedure information Filing cost estimate Prior art search U.S. filing assistance with patent attorney Foreign patent protection Patent licensing Financial assistance Other ___________________________________
Confidential Michigan Tech Enterprise Corporation
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