Yes Was the invention conceived or first actually reduced to practice in the performance of work funded, in whole or in part, by any federal grant(s), contract(s) or subcontract(s)? If yes, list below. No Will any federal sponsoring entity be acknowledged if information related to this invention is Yes published or disseminated to the scientific community? If yes, list below. No Administering Sponsor(s): Grant/Contract Number(s): Principal Investigator: Dept/Center: Was the invention conceived or actually reduced to practice in the performance of work funded, Yes in whole or in part, by 3rd party grant(s), contract(s), subcontract(s), Sponsored Research No Agreement(s), or consulting agreement(s)? If yes, list below. Administering Sponsor(s): Grant/Contract Number(s): Principal Investigator: Dept/Center: Were any additional funding sources involved? Yes No If yes, list below: Were any CSUN resources utilized? Yes No If yes, list below: If none of the above were utilized, please confirm: No Government/industry/non-profit/foundation/University funding or resources were used 6. Publication, Public Disclosure & Other Activities: Note: If the answer to any of the following questions is YES, please provide detailed information and attach any associated grants, abstracts, manuscripts, articles, presentations, etc. Please keep the Office of Research and Sponsored Projects informed of any future submissions or other possible public disclosures describing the invention. Yes Has the invention been described in any publication(s) (including abstracts)? No Yes Has a manuscript describing the invention been submitted or accepted for publication? No If Yes, name of publication, journal or website:
Was the invention conceived or first actually reduced to practice in the performance of work funded, in whole or in part, by any federal grant(s), contract(s) or subcontract(s)? If yes, list below. Yes No Will any federal sponsoring entity be acknowledged if information related to this invention is published or disseminated to the scientific community? If yes, list below. Yes No Sponsor(s): Grant/Contract Number(s): Principal Investigator: Administering Dept/Center: Was the invention conceived or actually reduced to practice in the performance of work funded, in whole or in part, by 3rd party grant(s), contract(s), subcontract(s), Sponsored Research Agreement(s), or consulting agreement(s)? If yes, list below. Yes No Sponsor(s): Grant/Contract Number(s): Principal Investigator: Administering Dept/Center: Were any additional funding sources involved? Yes No If yes, list below: Were any CSUN resources utilized? Yes No If yes, list below: If none of the above were utilized, please confirm: No Government/industry/non-profit/foundation/University funding or resources were used 6. Publication, Public Disclosure & Other Activities: Note: If the answer to any of the following questions is YES, please provide detailed information and attach any associated grants, abstracts, manuscripts, articles, presentations, etc. Please keep the Office of Research and Sponsored Projects informed of any future submissions or other possible public disclosures describing the invention. Has the invention been described in any publication(s) (including abstracts)? Yes No Has a manuscript describing the invention been submitted or accepted for publication? Yes No If Yes, name of publication, journal or website:
CSUN_Invention_Disclosure_Form_04_15.docx