Is there any third party involvement, such as collaboration with another university, sponsored research agreement, consulting etc? No Yes please provide details: – Please list commercial entities that may be interested in the material. What do you see as the best commercialization for this creation? 13. CONTRIBUTOR DATA SHEET: By signing below, each contributor certifies that he or she is a contributor, that the others named herein are contributors, and that there are no other contributors, to the best of his or her knowledge. If your contact information changes, it is your responsibility to notify WSU Ventures of your new address. If you cannot be contacted, any applications may be abandoned and/or you will not receive any royalties. WSU-AFFILIATED CONTRIBUTORS: NON-WSU-AFFILIATED CONTRIBUTORS: FACULTY AND/OR EMPLOYEE CERTIFICATION (for non-WSU and Student contributors, leave blank): Pursuant to WSU policy, I hereby acknowledge WSU’s ownership in the intellectual property described and disclosed in this form and hereby assign all of my right, title and interest to this intellectual property to WSU. This assignment includes both the right to claim priority and all rights in the invention. Wichita State University will share any net royalty income derived from the intellectual property with the inventor(s) according to the published policies. __________________________________________ ____________________ Faculty or Employee Contributor Signature Date __________________________________________ ____________________ Faculty or Employee Contributor Signature Date __________________________________________ ____________________
Is there any third party involvement, such as collaboration with another university, sponsored research agreement, consulting etc? No Yes – please provide details: Please list commercial entities that may be interested in the material. What do you see as the best commercialization for this creation? 13. CONTRIBUTOR DATA SHEET: By signing below, each contributor certifies that he or she is a contributor, that the others named herein are contributors, and that there are no other contributors, to the best of his or her knowledge. If your contact information changes, it is your responsibility to notify WSU Ventures of your new address. If you cannot be contacted, any applications may be abandoned and/or you will not receive any royalties. WSU-AFFILIATED CONTRIBUTORS: NON-WSU-AFFILIATED CONTRIBUTORS: FACULTY AND/OR EMPLOYEE CERTIFICATION (for non-WSU and Student contributors, leave blank): Pursuant to WSU policy, I hereby acknowledge WSU’s ownership in the intellectual property described and disclosed in this form and hereby assign all of my right, title and interest to this intellectual property to WSU. This assignment includes both the right to claim priority and all rights in the invention. Wichita State University will share any net royalty income derived from the intellectual property with the inventor(s) according to the published policies. __________________________________________ ____________________ Faculty or Employee Contributor Signature Date __________________________________________ ____________________ Faculty or Employee Contributor Signature Date __________________________________________ ____________________
Disclosure_Form_Copyrights_Trademarks_2015.docx