The information below will help UA employees complete the invention disclosure form available in MS Word format or online through Tech Launch Arizona's Inventor Portal.
If you need additional help or information, email Doug Hockstad, Director of Technology Transfer: firstname.lastname@example.org
The UA Invention Disclosure form is used to report an invention or technology made by faculty members, fellows and staff members (including students on appointment as University employees), by anyone using University facilities, or by anyone collaborating with any of the above individuals (“Contributors”).
This form is designed to help Tech Transfer begin to understand your research and begin our interactions with inventors/contributors. Inventions in this context, include new processes, products, software, apparatus, compositions of matter, living organisms or improvements to existing technology with commercial potential.
Click to visit the Inventor Portal (Requires NetID)
Alternatively, you can download a Microsoft Word version of the Invention Disclosure form here.
Title of the Invention
Use a brief title, omitting any confidential information, acronyms, and trademarks (title should be generic).
Write a general description of the invention, concisely describing what you consider to be the essence of the invention and capturing the essential core concepts and results, including advantages and features of the invention. Also:
- Please attach a detailed description of the invention, advantages/improvements over existing methods/devices/materials, and possible modifications;
- Please attach any related manuscripts, publications, presentations, posters, etc.; and
- Please do not include any ITAR restricted/controlled information.
Voice of the Inventor
In your own words, provide a concise description of the technology and how you think it could be used. Keep it brief — just one or two sentences will do.
The University is required to report all inventions made with Federal funding to the relevant agency, so it is imperative that you provide details on all federally funded inventions, in particular, the agency and the grant number.
Please list all other potentially relevant grants, funds, collaborations, or materials received from third parties such that we can do the appropriate reporting to the sponsoring groups and determine if there are any pending license rights to the invention.
Provide accurate dates and comments to enhance the understanding of critical events and/or make a note that you wish to discuss these issues with us. We are interested in any potential public disclosure (papers, posters, abstracts, talks, etc. - including those that are planned) of the invention, to help us and our lawyers evaluate any potential patent protection issues.
Contributors are individuals who may have conceived or developed elements of the invention, either independently or jointly with others.
If this Invention Disclosure results in a patent application, a patent attorney will determine inventorship based on information from contributors listed in this form. Fill in the “Contribution %” for UA Contributors only to provide your assessment of each individual’s relative contribution to the concepts of the invention.
License revenues, if any, will be distributed according to University policy. The first individual listed will be TLA’s primary contact, and agrees to act as the conduit of information with the other contributors.
Please provide complete addresses (including city, state, zip.) Any non-UA affiliation should be stated (e.g., corporate, Department of Veterans Affairs (VA), other university or universities, or joint appointments).
Attach an Additional Contributors page if necessary. If contributions of a Contributor are affiliated with more than one department, TLA will need the names of each relevant department and a breakdown of the “Contribution %” of that Contributor applicable to each department (due to revenue sharing with each department).
The best way to do this is to use a separate entry for each department of the Contributor. For example, if Contributor A is has a “Contribution %” of 20% and is affiliated with both Dept. X and Dept. Y, and the invention was made 60% under the auspices of Dept. X and 40% under the auspices of Dept. Y, then the Contribution % for this Contributor A should be 12% for the entry for Dept. X and 8% for the entry for Dept. Y.
If this breakdown is not provided, then each department will be weighted equally.
Declaration and Submission
All contributors must review and sign the Declaration. Please e-mail your completed form to email@example.com and follow up by mailing the original form (plus any Additional Contributor pages) to Tech Launch Arizona, “Attention: Invention Disclosures.”
Attorney-Client Privileged Communication
The information in this Invention Disclosure is confidential and should not be disclosed to persons outside the University or to persons not requiring access to this information.