Employee Non Disclosure Invention by czk33710

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									                                                  INVENTION DISCLOSURE FORM
                                      Brigham Young University - Provo, Utah 84602



      Descriptive Title:



      Was any Federal funding used in the development of this invention? _____ Yes _____ No

      Identify all persons who contributed to the conception of the Invention:*

Full Name                   Home Address                             Campus Phone             Soc. Sec. No              Email                US Citizen*
                                                                                                                                                  Y/N




      (Note: An inventor is an individual who conceives a definite and permanent idea of the complete and operative invention as it is
      thereafter to be applied in practice. It does not have to be proven to be operative. The testing of the invention to show that it is
      operative is reduction-to-practice. Reduction-to-practice has nothing to do with inventorship.)

      Received by BYU Technology Transfer Office:

                              Name                                                        Date

                             Signature

      Technology Transfer Review:
      ______________________      ______________
                                                                  Approved                                   Released

      Committee Review:                                                                 ______
      ______________________
                                                                   Approved                                  Released

      Committee Comments:___________________________________________________________
      ______________________________________________________________________________
      ______________________________________________________________________________
      ______________________________________________________________________________
      Patent Counsel:                                                        Application Submitted:_________________
      *If not US citizen, indicate citizenship.
      TT-115
                            INVENTION DISCLOSURE FORM


                                          Instructions



       The following Confidential Disclosure will officially document the details of an
Invention and establish an official record of its conception and/or reduction to practice by the
date of this submission. Complete this form as carefully and completely as possible. The
information contained herein may be used in legal actions to defend the patent and will be used
by the Patent Review Committee to determine if BYU will pursue a patent application and/or
commercial development. This information will also be used in the initial preparation of the
patent application. This form may suggest the necessity of additional information. If it is
possible, please obtain such information prior to submission.

        As a condition of employment at BYU all employees (i.e., faculty, staff, administration
and employed students) assign all rights to any Invention or Creative Work which is conceived,
developed and/or reduced to practice within the scope of said employment and/or which
significantly utilizes BYU resources.* An "Assignment and Royalty Agreement" to confirm the
assignment and to acknowledge the university's commitment to share any royalties or other
income with the inventor should be executed by each inventor, and an "Income Distribution
Agreement" should be completed to designate the distribution of royalties between multiple
inventors.

       Return the completed form to:

              Technology Transfer Office
              A-285 ASB
              Brigham Young University
              Provo, UT 84602
              (801) 422-6266



* Inventions which are not within the field of employment and did not employ BYU resources
should not be disclosed on this form, but a brief, non-confidential description of the Invention
should be submitted to the Technology Transfer Office with a copy to the employee's chairman
or director to request release of the Invention to the employee. Non-employed students have no
obligation to disclose.
Brigham Young University
Technology Transfer Office

                             INVENTION DISCLOSURE
I.    The Invention:

      A.     Brief description of the Invention:




      B.     Purpose of the Invention (problems solved by the Invention):




      C.     Where and how the Invention is to be used (potential customers):
                                                                     Confidential Information

II.   Previous Work ("Prior Art"):

      A.     A literature and patent search must be completed prior to initiation of a patent
             application.

             Has a literature search been completed?



             Has a patent search been completed?



      B.     Give a brief description of the closest prior art (patents, printed publications,
             public knowledge, public use, products, processes, equipment, etc.):




      C.     Differences between the Invention and the prior art:




      D.     Advantages of the Invention over the prior art:
                                                                          Confidential Information

III.   Public Disclosure (disclosure means enough information to reproduce the Invention):

       A.     Identify all printed publications (U.S. and foreign) in which the Invention is
              described in whole or in part and indicate date of publication (attach photocopies):




       B.     Identify all patent applications and patents (U.S. and foreign) in which the
              Invention is described in whole or in part (attach photocopies):




       C.     Persons (other than the inventors), companies, institutions and government
              agencies to whom the Invention has been disclosed (was a non-disclosure
              agreement signed?):




       D.     Use of the Invention:

              1)     Date of first public use or sale:

              2)     Date of first use or sale in U.S.:

              3)     Date of first public use or offering for sale:
              4)     Date of first public use or offering for sale in U.S.:

              Note: If there is no such date, indicate "none" in the appropriate space.
                                                                              Confidential Information

IV.    Identify all patent applications and patents of the inventor(s) which are related in any way
       to the Invention:




V.     Is BYU under any obligation through a research contract, etc. to license or assign the
       Invention? Was research supported by a Federal or State grant or contract?
       Indicate below and briefly describe the relevant facts:
       Please indicate agency and contract/grant number(s) if Federal/State grants or contracts were used:
       ______________________________________________________________________________________




VI.    Indicate any individual or organization that might be interested in licensing a patent to the
       Invention.




VII.   Identify all foreign countries where patent protection is, or may be, desired (this matter
       must be considered now or foreign patent rights may be lost):
                                                                        Confidential Information

VIII.   If the Invention is incorporated into, or is used in combination with a computer program,
        describe briefly:




IX.     Provide any other information that you feel is relevant to the Invention or to the
        protection or exploitation of the Invention:




X.      Detailed description of the Invention and how it functions (include drawings, sketches,
        and flow charts if appropriate; describe the preferred embodiment of the Invention;
        describe the inventive concept in broad or generic terms; describe operation of the
        Invention through one complete cycle, etc):
                                                                        Confidential Information


Signature(s) of the Inventor(s):



1.
                       Signature                                     Date

2.
                       Signature                                     Date

3.
                       Signature                                     Date

4.
                       Signature                                     Date




Witnesses:

        We, the undersigned, have read this Invention Disclosure and understand its contents.



                       Signature                                       Date




                       Signature                                       Date




Inventor(s) and Witnesses should initial and date the bottom of each page attached hereto.




(TT-115) 5/95

								
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