Ca Property Disclosure

							Ann Dulhanty
Manager, Office of Technology Transfer & Commercialization
Office of the Associate Provost, Research
Tel: (905)-721-8668 x 6522 Fax: (905)-721-3119 email: ann.dulhanty@uoit.ca

                   CONFIDENTIAL INTELLECTUAL PROPERTY DISCLOSURE


   1. a) Inventors:

       SURNAME, GIVEN         DEPARTMENT AND           BUSINESS CONTACT      CURRENT HOME ADDRESS AND
           NAMES                   POSITION              INFORMATION                CITIZENSHIP
                               (e.g. faculty, PDF,       (phone, e-mail)
                               student, staff, or
                              external employer)




   1. b) Non-Inventive Contributors:
      If applicable, please list other individuals who have made a significant contribution to this
      Intellectual Property but whose role was not substantially “creative” in nature. For clarification
      please discuss with Manager, Technology Transfer & Commercialization.




   2. How was the work leading to this Invention funded?

  To be completed by OTTC:

  DATE RECEIVED:                                     DISCLOSURE REFERENCE #:
                  SPONSOR(S)                               GRANT OR CONTRACT FUND #




3. Where did the work leading to this Intellectual Property take place (UOIT or elsewhere)?



4. Have these results been presented or published in any form?
   (For clarification on confidentiality please discuss with Manager, Technology Transfer &
   Commercialization)



5. Brief Description:
   (Please highlight the novelty and potential applications of this Intellectual Property;
   attach a separate sheet if necessary)




6. Is this Intellectual Property subject to any 3rd party materials that may have been used
   during development such as software, commercial plasmids, MTA agreements or
   under research contracts with partners external to UOIT?

   ______NO

   ______YES (If “Yes”, please provide details)




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7. Warranty:

   I/We, the Inventors listed in Section 1(a), have read, understood and agree to all of the
   preceding and declare that all of the information provided in this disclosure is
   complete and correct. To the best of our knowledge, all persons who might legally
   make an ownership claim in this Intellectual Property are identified in Section 1(a).


   Inventor:                                          Inventor:

   ______________________________________ _____________________________________
   SIGNATURE                              SIGNATURE

   ______________________________________ _____________________________________
   PRINT NAME                             PRINT NAME

   ______________________________________ _____________________________________
   TITLE                                  TITLE

   ______________________________________ _____________________________________
   DATE                                   DATE


   Inventor:                                          Inventor:

   ______________________________________ _____________________________________
   SIGNATURE                              SIGNATURE

   ______________________________________ _____________________________________
   PRINT NAME                             PRINT NAME

   ______________________________________ _____________________________________
   TITLE                                  TITLE

   ______________________________________ _____________________________________
   DATE                                   DATE




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Invention Disclosure Process

Under UOIT’s Intellectual Property Policy, Academic personnel own the Intellectual Property they
create but are obligated to disclose it to the Office of Technology Transfer and
Commercialization. If the creators choose to offer the Intellectual Property to the University for
commercialization, the University reserves the right to determine at its sole discretion if it wishes
to accept such intellectual property for commercialization.

If UOIT accepts the technology for commercialization, the creator(s) of the invention will then
enter into an agreement with UOIT in which the creator(s) assign all Intellectual Property rights
and other rights to UOIT. UOIT assumes sole responsibility and authority for legally protecting
and marketing the intellectual property, finding a licensee or buyer, and negotiating a license or
sale and administering that agreement. The University shall share with the creator(s) revenue
derived from the licensing or sale of the technology.

For more information about your rights under UOIT’s Intellectual Property policy please visit the
following website http://research.uoit.ca/EN/main/231307/research_policies.html .




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