ࡱ> #` bjbj\.\. 6>D>D3EjjjD CCC8VCD6kDJ" K K KBLP$&R j"j"j"j"j"j"j$lh'oFjAjZ>L>LZZFj K K4k\\\Z K8 K j\Z j\\4e Rg KD P=C3Z@g:g<k0kzg:oIZotgojg0:SUD\DVHW:S:S:SFjFj[:S:S:SkZZZZ666/d666/~D,  FORMTEXT  THE UNIVERSITY OF TEXAS M.D. ANDERSON CANCER CENTER OFFICE OF TECHNOLOGY COMMERCIALIZATION INVENTION DISCLOSURE REPORT In the electronic version of this form the space will expand as you type. Use the tab and/or page up/page down keys to navigate between form fields. Attach additional material as required. This form is available on our HYPERLINK "http://www.mdanderson.org/departments/techcommerc/"Webpage. Refer to the Handbook of Operating Procedures, Vol. II, Section L for the M.D. Anderson Cancer Intellectual Property Policy. For assistance with this form, call 2-7598. The purpose of this INVENTION DISCLOSURE REPORT is to: Provide a complete description and documentation of an invention. Serve as the basis for evaluation of patentability and commercial potential by the Office of Technology Commercialization. Serve as the basis for preparation of patent application(s). Note: In order to secure a valid patent, you must: Disclose all persons who made a creative contribution to the conception and/or reduction to practice of the invention. 2. Describe the best embodiment of the invention. 3. Describe all data/information pertaining to the invention, whether or not it directly supports the invention. Failure to complete this form in its entirety will result in it being returned to you for completion and will delay commercialization efforts by the Office of Technology Commercialization. Upon completion of the form, print it out, make sure all creators have signed it, and return it to Unit 510. In addition, the form may be returned electronically via email to cstrobel@mdanderson.org with a signed hard copy to follow. General Information for the Creators Office of Technology Commercialization Invention Assessment Process: An invention disclosure is first assessed by a Technology Analyst, who makes an initial determination of its patentability and market potential for the Office. These findings are discussed at Office meetings with patent counsel and Office of Technology Discovery staff, and recommendations are made during these meetings to proceed with commercialization efforts or to retain the invention as preliminary. Patent applications may be filed by MDACC on those inventions in which the decision is to proceed with commercialization efforts. If the decision is not to proceed with commercialization efforts, the creators are notified that they may pursue patent and commercialization efforts on their own if they so elect, subject to applicable UT System and MDACC policy. Inventions designated preliminary are felt to be promising, but not yet developed to the point at which patenting or marketing is appropriate, and these are monitored for further progress and re-evaluated by the Office as new developments permit. Requirements for Patentability: Patentability of an invention is primarily assessed based on three criteria established by the U.S. Patent and Trademark Office. The first is the requirement for usefulness of the invention, which is usually easy to meet. The second is the requirement for novelty. A patent will not be issued if the invention was known or used by others in the U.S. or patented or described in a printed publication in any country before the MDACC creator(s) made the invention. The third criterion is the requirement for non-obviousness. To meet this requirement, the subject matter of a patent application must be sufficiently different from what has been known, used or described before in that field that it would not have been obvious to a person having ordinary skill in the area of technology relating to the invention. Requirements for Inventorship: Inventorship is a matter of U.S. law. Inventors are those who make a creative contribution to the invention claimed in a patent, either in the original conception or in bringing the original conception to fruition. Those who simply perform experiments without contributing any creative element are not inventors from a legal standpoint. In cases where inventorship is disputed, a legal determination of inventorship will be performed by a patent attorney in conjunction with putative inventors. Encumbrances to Licensing: It is particularly important to disclose funding sources and relationships with industry that are pertinent to the invention (particularly the existence of agreements such as materials transfer agreements, sponsored research agreements, clinical study agreements, etc.) as these may have critical bearing on how an invention is patented, marketed and licensed (see sections 6-8 below.) Title of Invention:  FORMTEXT       Abstract: Please provide a summary of the invention.  FORMTEXT       Creators of the Invention: Name each person who was involved in conceptualizing and creating the invention, briefly describe their creative action/activity, and their percentage contribution to the invention. The Percentage Contribution is used as a general guide to calculate the creators share of royalties should this invention be commercialized. Note however, that the determination of inventorship is a matter of law, and is determined at the time of patent filing when patent claims are drafted and again at the time of patent issuance depending on what claims in a patent ultimately issue into a granted patent. In many cases those persons listed in this section may not be true inventors under law. If a creator was employed by an institution OTHER than MDACC at any time during their creative contribution to the invention, please note the percentage contribution when at that employer. Use additional pages if necessary. a. Name and Creative Activity:  FORMTEXT       % Contribution:  FORMTEXT       b. Name and Creative Activity:  FORMTEXT       % Contribution:  FORMTEXT       c. Name and Creative Activity:  FORMTEXT       % Contribution:  FORMTEXT       d. Name and Creative Activity:  FORMTEXT       % Contribution:  FORMTEXT       Date the invention was conceived (when you first thought of it or made the key observation): FORMTEXT       Date you made the first drawing, design, formulation, construction or model, if applicable:  FORMTEXT       Date of the first use of the invention, if applicable:  FORMTEXT       M.D. Anderson Employees: Were you employed elsewhere during any part of the creation of the invention? If so, please provide the employer s name and address, and the dates of your employment there.  FORMTEXT       Has/will the invention been/be described in a meeting, poster session, seminar, published paper, or abstract (check all that apply and attach copies if appropriate)? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If Yes, please provide the following information: Name of Journal/Meeting:  FORMTEXT       Date of submission:  FORMTEXT       Date of Publication/Presentation (estimate if specific date unknown):  FORMTEXT       Date of Electronic Publication (in full or abstract) on Internet, World-Wide-Web, Subscriber Service etc:  FORMTEXT       Was the disclosure sufficient to allow someone else to duplicate the Invention? Yes  FORMCHECKBOX  No  FORMCHECKBOX  List all sources of funding that supported the conception of the invention and/or the inventions reduction to practice. (Company, Institution, Various Donors Account, Government Agency, or Private Foundation, etc.) Use additional pages if necessary. Funding Source:  FORMTEXT       Project Title:  FORMTEXT       Number:  FORMTEXT       MDA Acct No.:  FORMTEXT       Principal Investigator:  FORMTEXT       Funding Source:  FORMTEXT       Project Title:  FORMTEXT       Number:  FORMTEXT       MDA Acct No.:  FORMTEXT       Principal Investigator:  FORMTEXT       a. Was this invention derived from materials received from another investigator or from a company? Yes  FORMCHECKBOX  No  FORMCHECKBOX . If yes, please name the institution or company from which the material was obtained and provide a copy of the Materials Transfer Agreement (if applicable.)  FORMTEXT       b. Was this invention derived or made using a biological sample from one of UTMDACC s specimen banks? Yes  FORMCHECKBOX  No  FORMCHECKBOX . If yes, please identify the source of the sample, and, if known, identify the study under which the sample was collected and investigator collecting the sample. If available, please provide a copy of the study agreement or other agreement under which the sample was collected. Has the invention been transferred to any third party under a material transfer agreement or otherwise? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Is this invention related in any way to a contractual agreement that any of the creators listed in No. 3 above have with a company or other institution? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If Yes, select the type of agreement below and indicate the name of the other company/institution, as well as the contract number if known. Sponsored Research Agreement  FORMCHECKBOX , Clinical Study Agreement  FORMCHECKBOX , Laboratory Study Agreement  FORMCHECKBOX , Consulting Agreement  FORMCHECKBOX , Other contractual agreement  FORMCHECKBOX  Name of party to agreement and contract No.  FORMTEXT       Please provide names of M. D. Anderson faculty/staff (or others) whom you believe have sufficient technical knowledge in this field to serve as scientific reviewers of  g h ^ @ \ n p r Qh纱||xs hc>*hchc5>*@CJhc0JCJjvhc5CJUjhc5CJU hc5CJhc5@CJhc@CJ&jhcCJOJQJUmHnHu!jhcCJOJQJUhcCJOJQJjhcCJOJQJU*  ^ _ S = o  0*$^ & F 0*$ 0*$ & F h088d,*$^8 0d,*$ $ 0*$a$ $ H*$a$|LMab "\"^""  & F h & F  & F h $0 $*$ 0*$ $ 0*$a$KLMmab~#$  ~'*Ķo^oShc5CJOJQJ!jhcCJOJQJU&jhcCJOJQJUmHnHu!jMhcCJOJQJUjhcCJOJQJUhcCJOJQJhc@CJaJhc5@CJ hc5hc@OJQJhc5@OJQJhcOJQJhc5>*CJ hc>* hcCJhc hc5>* *+ ! !*!+!" 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FORMTEXT       Please complete 11a. through 11f. in the spaces below or on separate sheets. What is the invention and how could it be used?  FORMTEXT       How does the invention provide a competitive advantage relative to existing technology (e.g., does it yield better or quicker results? Is it easier to use? Is it more cost-effective?) or how does the invention permit something completely new to be done? Please answer in detail.  FORMTEXT       Summarize the results of your in vitro and/or in vivo experiments and describe to what extent the experiments have been verified.  FORMTEXT       Does a prototype exist? Yes  FORMCHECKBOX  No  FORMCHECKBOX  What products and/or services could be sold utilizing your invention?  FORMTEXT       What are your clinical development plans? What are the steps that must be taken to complete the basic research and pre-clinical research (toxicology, pharmacokinetics, tissue distribution, animal efficacy, etc.)? Which steps will you perform and which steps will be done by collaborators and who are they?  FORMTEXT       What companies might be interested in selling products or services using your invention (provide the name, address, and phone number of a contact person at each company, if known)?  FORMTEXT       Do you wish to participate in research related to the commercial development and/or clinical testing of products/services arising from this invention? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Attach your experimental procedures and data. You may attach a grant application, a manuscript, or poster. Attach a sketch, drawing, photograph, etc. if applicable. Enclose copies of all references that are directly relevant to your invention, including all relevant manuscripts, publications, and abstracts by any of the creators. 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