INVENTION DISCLOSURE FORM This form is intended for University of Chicago, UChicago Medicine, Marine Biological Laboratory, & Toyota Technical Institute faculty, researchers, and staff. Otherwise, if you would like assistance with your invention, consider becoming a member of the Polsky Exchange (more information at polsky.uchicago.edu/become-a-member/). This form requests the minimum information needed to effectively evaluate your disclosed invention (including software). As the disclosing inventor, it is your obligation to provide a thorough and candid disclosure. Note, submitting an Invention Disclosure does not provide patent protection. To learn more about the patent process, or if you have any other questions when completing this form, please contact our office at 773.702.1692 or PolskyLicensing@uchicago.edu. THIS SECTION IS FOR OFFICE USE ONLY INVENTORS CONTINUE TO PAGE 2 — DATE RECEIVED: UCHI ASSIGNED: RECEIVED BY: PM/APM: OF INVENTION OR SOFTWARE date OF INVENTION In order to process your disclosure and to facilitate compliance with any external reporting – requirements please indicate the date of invention as accurately as possible. – PUBLIC DISCLOSURE Public Disclosure can be in the form of an abstract, manuscript, poster, or other publication (including manuscript drafts on ARXIV). Be sure to cite all instances of public disclosure. PAST PUBLIC DISCLOSURE Was any aspect of this invention published, described, or publicly YES NO presented IN THE PAST (e.g., web, journal, dissertation, etc.)? If YES, describe below, including relevant dates and locations:
INVENTION DISCLOSURE FORM This form is intended for University of Chicago, UChicago Medicine, Marine Biological Laboratory, & Toyota Technical Institute faculty, researchers, and staff. Otherwise, if you would like assistance with your invention, consider becoming a member of the Polsky Exchange (more information at polsky.uchicago.edu/become-a-member/). This form requests the minimum information needed to effectively evaluate your disclosed invention (including software). As the disclosing inventor, it is your obligation to provide a thorough and candid disclosure. Note, submitting an Invention Disclosure does not provide patent protection. To learn more about the patent process, or if you have any other questions when completing this form, please contact our office at 773.702.1692 or PolskyLicensing@uchicago.edu. THIS SECTION IS FOR OFFICE USE ONLY — INVENTORS CONTINUE TO PAGE 2 DATE RECEIVED: UCHI ASSIGNED: RECEIVED BY: PM/APM: OF INVENTION OR SOFTWARE date OF INVENTION In order to process your disclosure – and to facilitate compliance with any external reporting requirements – please indicate the date of invention as accurately as possible. PUBLIC DISCLOSURE Public Disclosure can be in the form of an abstract, manuscript, poster, or other publication (including manuscript drafts on ARXIV). Be sure to cite all instances of public disclosure. PAST PUBLIC DISCLOSURE Was any aspect of this invention published, described, or publicly presented IN THE PAST (e.g., web, journal, dissertation, etc.)? YES NO If YES, describe below, including relevant dates and locations: