Have you disclosed the innovation in an abstract, manuscript, conference document, presentation, news story, thesis, or conversation? If yes, please provide: The date: Form/format of disclosure: Please attach a copy of disclosure or details of disclosure. Do you plan to have a publication or other disclosure in the next 6 months? If yes, please provide: The predicted date: Form/format of disclosure: Please attach a copy of drafts, preprints, etc. Have you disclosed your innovation to industry representatives? If yes, please provide: The name of the company: The company representative(s): Name: Email: Phone number: Has there been any sale, offer of sale, commercial testing or public use of the innovation? If yes, please provide: The date of the sale: Form/format of disclosure: Please attach a copy of the details. Sponsorship / Funding Was the research that led to the innovation sponsored? If yes, please provide: Sponsor Name: Sponsor/Agency ID#: #:
Have you disclosed the innovation in an abstract, manuscript, conference document, presentation, news story, thesis, or conversation? If yes, please provide: The date: Form/format of disclosure: Please attach a copy of disclosure or details of disclosure. Do you plan to have a publication or other disclosure in the next 6 months? If yes, please provide: The predicted date: Form/format of disclosure: Please attach a copy of drafts, preprints, etc. Have you disclosed your innovation to industry representatives? If yes, please provide: The name of the company: The company representative(s): Name: Email: Phone number: Has there been any sale, offer of sale, commercial testing or public use of the innovation? If yes, please provide: The date of the sale: Form/format of disclosure: Please attach a copy of the details. Sponsorship / Funding Was the research that led to the innovation sponsored? If yes, please provide: Sponsor Name: Sponsor/Agency ID#: #:
word_ip_innovation_disclosure.docx