WPC|- ;}IRm;f jcû-:p7G9C/P+hjv fsĬ 0qHNlMxyUaHXy&&J$S&~_b VyR_P/2kS&zUR70nw"߇VTO{1eL*y"':tۦf \+|?L'cL&ٛ"qq`ֲ2P<YQ}^oam+;h]JteIqIх(8eR.%dȖ?/ #|=sq e޸oDs]d2!ibpK&Yoe tCI߭& fӯ4AN~;5=FIju6q[.a ,Aʒ#=h98`k`%u, 0hU>< 0 0^ 0( 0 0 0z 0 0z 0z 0 0 0^ 0z@ 0 0W 0W! 0Lx 1ir"" 0Cj# # 0C$% B % D3&4& 0C& 0(=' AMe' D+'"'>'=,U@M, %,, 0(, 1m,w@(-4h-<uj:Default Para  Q\  `$Times NewRomanQXXXQ\  `$Times NewRomanQ\  `$Times NewRoman. ,TOC 1  X   X    (#T$  XXXQ\  `$Times NewRomanQ       XXXQ\  `$Times NewRomanQ. ,TOC 2     X  4(#T$  XXXQ\  `$Times NewRomanQ       8.` hp x (#8XXXQ\  `$Times NewRomanQ. ,TOC 3     X   (#T$  XXXQ\  `$Times NewRomanQ       8.` hp x (#8XXXQ\  `$Times NewRomanQ. ,TOC 4  `   X   (#T$  XXXQ\  `$Times NewRomanQ       8.` hp x (#8XXXQ\  `$Times NewRomanQ. ,TOC 5     X  <(#T$  XXXQ\  `$Times NewRomanQ       8.` hp x (#8XXXQ\  `$Times NewRomanQ. ,TOC 6  X    (#T$  XXXQ\  `$Times NewRomanQ      XXXQ\  `$Times NewRomanQ. ,TOC 7  X    XXXQ\  `$Times NewRomanQ      >4,JR Z bj #>XXXQ\  `$Times NewRomanQ. ,TOC 8  X    (#T$  XXXQ\  `$Times NewRomanQ      XXXQ\  `$Times NewRomanQ. ,TOC 9  X    (#T$  XXXQ\  `$Times NewRomanQ      XXXQ\  `$Times NewRomanQ2 0Index 1     X P XXXQ\  `$Times NewRomanQ       XXXQ\  `$Times NewRomanQ2 0Index 2     X  4(#T$  XXXQ\  `$Times NewRomanQ       8.` hp x (#8XXXQ\  `$Times NewRomanQ:~8TOA Heading (#T$XXXQ\  `$Times NewRomanQ;1R Z bj #;XXXQ\  `$Times NewRomanQ20Caption;14 <DL!T$;XXXQ\  `$Times NewRomanQ8.4 <DL!(#8XXXQ\  `$Times NewRomanQ<jj:_Equation CaQ\  `$Times NewRomanQXXXQ\  `$Times NewRomanQ0.Header !(#XXXQ\  `$Times NewRomanQ;1R Z bj #;XXXQ\  `$Times NewRomanQ0.Footer !(#XXXQ\  `$Times NewRomanQ;1R Z bj #;XXXQ\  `$Times NewRomanQ:j8Page NumberQ\  `$Times NewRomanQ>4,JR Z bj #>XXXQ\  `$Times NewRomanQ' CONFIDENTIAL FOffice of Technology Licensing 0 .   $35;AGMU]c1I.A.1.a.(1)(a)i)a) g)  X=RXX%XXX    Ӏ  (2g$ (!    g*  X=RXX%XXX    E1X` hp x (#%XEE14 <DL!T$XXE(2g$ (!   g)  X=RXX%XXX    E1X` hp x (#%XEӀ   d'dxd Level 1 Level 2 Level 3 Level 4 Level 5(2g$ (!  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HCINVENTIONDISCLOSURE  OFFICEOFTECHNOLOGYLICENSINGUniversityofFlorida  H4XX` hp x (#%XXH   lXX=R  &q&lPurposeandFormatofInventionDisclosureForm   X  X    ThisformisusedtodiscloseaninventionasrequiredunderUniversityofFloridaRule6C17.0392,F.A.C.(explainedintheUniversityofFloridaIntellectualPropertyPolicy).(Ifa work,whichrefersingeneraltocopyrightablematerial,mustbedisclosed,thedisclosureshouldbeontheformentitled WorkDisclosure.)Aninventiondisclosureshouldbemadewhensomethingnewandusefulhasbeenconceivedordeveloped,orwhenunusual,unexpected,orunobviousresearchresultshavebeenachievedandcanbeutilized.  TheUniversityofFloridaneedstheinformationrequestedinthisformtopermitevaluationofyourinventiontodeterminewhethertheinventionispatentableandwhethercommercialdevelopmentisfeasible.TheinventionshouldbeclearlydescribedinSection1ofthisformsothatsomeonehavingknowledgeinthefieldoftheinventioncanunderstandthetechnicalmeritsoftheinvention,itsusefulness,andpossiblepracticalapplications.Informationthathelpsevaluatorsappreciatetheinventionwillincreaseitsultimatechancesforsuccessfulpatenting,ifthatisappropriate,andlatermarketdevelopment.  Theremainderofthedisclosureformcoverscertaingeneralissuesthatneedtobetakenintoaccountwitheveryinvention.ThesubjectcoveredinSection4isofparticularimportanceasthepublicdisclosureoftheinventionplacesseverelimitationsonavailablepatentprotection. Nonconfidentialdisclosureofaninvention(topeople  outsidetheUniversity)mayinitiateaoneyearperiodwithinwhichaUnitedStatespatentapplicationmaybefiled.Ifanapplicationisnotfiledwithinthattime,U.S.lawpreventsonefromobtainingpatentprotectionofthedisclosedinvention.Thepatentlawsofmostothercountriesareevenmorestrict:ingeneral,therighttopatentprotectionislostimmediatelyuponpublicdisclosureunlessaU.S.patentapplicationisfiledpriortosuchdisclosure. Thus,toensurethepossibilityofworldwidepatentprotection,itisimportantthatinvention  disclosuresbesubmittedfortimelyreviewsothataU.S.patentapplicationcanbefiledbeforepublicdisclosureoccurs.  InformationusedindeterminingrightstotheinventionisrequestedinSection5.Identificationofthefinancialsupportusedduringthedevelopmentoftheinventionhelpsdeterminewhethertherearecontractualobligationstoexternalresearchsponsorsthatmayaffectsuchrights.  InSection6,youaretoidentifytheindividualswhoareinventorsofthetechnologydisclosed.ItisimportanttonotethatinventorshipisdeterminedpursuanttoUnitedStatespatentlaw.Thus,thislistmayneedtoberevisedduringtheprocessinordertoaccuratelyreflectthenamesofinventors.InSection7,onlythepersoncompletingthedisclosureformandthedepartmentchairpersonneedtodateandsigntheform.  Allquestionsareimportant,sopleaserespondtoeachofthemeveniftheansweris noneor notapplicable.Ifmorespaceisneeded,feelfreetouseadditionalsheets.Foranyquestionsregardingthisform,pleasecalltheofficeat(352)3928929.  C  $$C"  d,'. "XXX  X=RX&&q#     `       `     h      p     UXX=R UF#________X=RXU  H   X  E1X` hp x (#%XXXE CONFIDENTIALB  ԍ\ E51Z \ @@\ߎC   N C!  H>CINVENTIONDISCLOSURE >   H4XX` hp x (#%XXH 1.  DisclosureofInvention     X    Aninventionincludesanydiscovery,newandusefulprocess,compositionofmatter,articleofmanufacture,knowhow,design,model,technologicaldevelopment,biologicalmaterial,strain,variety,cultureofanyorganism,orportion,modificationtranslation,orextensionoftheseitems,andanymarkusedinconnectionwiththeseitems.Underpatentlaw,thismayincludedrugs,newlydiscovered,mutatedorgeneticallyengineeredmicroorganismsorplants,neworalteredformsofplantlife,vaccines,cells,tissueandorgancultures,productsofrecombinantDNAresearch,hybridcellcultures,processesinvolvingmicroorganisms,monoclonalandpolyclonalantibodies,engineeredproteins,andsomecomputerprogramsanddesigns.  X    A.  TITLE: ________________________________________________________ ^  XX=R     `  (Brief,butcomprehensive,technicallyaccurate,anddescriptive)X=RX  N    P0  01񀀀1 B.  CONCISEDESCRIPTIONOFTHEINVENTION: Yourdisclosureshouldenablesomeone  havingknowledgeofthefieldtounderstandtheinvention.Includeessentialelements(features,concepts,ornewresultsoftheinvention,whicheverismostapplicable),theirrelationshiptooneanother,andtheirmodeofoperation.Identifytheelementsthatareconsiderednovel.Also,iftheinventionisanapparatusorsystem,attachdrawingsorasketchandindicateifithaseverbeenbuiltortested.Useadditionalpages,attachdrawings,manuscripts,papers,orothersupportingmaterialtofacilitateunderstandingtheinvention.Attachanydatawhichshowsthattheinventionworks. P    \  2.  Uses/Usefulness/AnyAdvantagesoftheInventionoverCurrentlyAvailableTechnology  X  X    Describewhatispresentlyinthefield.Identifyexistingdevicesorprocesses(andtheirshortcomings)andlistanypublishedmaterialsuchaspatents,commercialliterature,scientificarticlesrelatingtotheinvention.Identifytheadvantagesorbenefitsoftheinventionovercurrentlyavailabletechnology,suchasefficiency,costbenefit,simplicity,overcomingadefect.Identifypossibleusesornewusesoftheinvention(especiallyimportantiftheinventionisachemicalcompound).  X  3.  PotentialCommercialApplicationsoftheInvention/PotentialLicensees  h    P2  23񀀀3 A.   Ifyouareawareofadefinitivelicenseeoraresearchsponsorwhowilllicensethisinvention,we H mustknowimmediately.Pleaseindicatethatcompany(withspecificindividualandphonenumber)inthespacebelow: P       _________________________________________________________________   P4  45񀀀5 B.   Wherewouldyourinventionhavethemo77stcommercialvalue?Pleaseindicateyourevaluationby  rankingthefollowinggeographicareas(1beingthehighest). P       UnitedStates _______ h Japan    6 p 6_________ `     Europe _______ h Other(Pleasespecify)_________ P   C.   Pleaseestimatetheannualsalesofyourinventionthreeyearsafterproductlaunch,andexplain 0 Ѐhowyouarrivedatthisnumber.$_____________________      D.   Haveyoucommunicatedwithanyindustryrepresentativeregardingyourinvention? H!!     YES______ NO_______ 8""     DateofDisclosure  _______________________________________ $!$     Company   _______________________________________ %"%     Address   _______________________________________ %#&     City/State/Zip   _______________________________________ &$'     TelephoneNumber  _______________________________________ '%(     IndividualContact  _______________________________________ (p&)     OfficialTitle   _______________________________________ )`'*   *P(+   E.   Wassuchdisclosuremadeunderaconfidentialityagreement?YES_____NO_____ X   F.   Doyouwishtolicensethisinventionforyourowncompany?YES_____NO_____ 8   G.   Doyouwishtocontinueresearchonthisinventioniftheentitylicensingtheinventionprovides  Ѐfunding?YES_____NO_____ 4.  PublicDisclosure/PublicationPlans    X    Publicdisclosureincludesabstractsandpresentationsatscientificmeetings(includingpostersessions),publicseminars,shelvingoftheses,publications,disclosuretoothersoutsideoftheUniversitywhohavenotsignedaconfidentialityagreement,andtheuse,sale,orofferofsaleoftheinvention.Identifydatesandcircumstancesofanysuchdisclosures.Also,indicateyourfuturedisclosureorpublicationplans,andNOTIFYtheOfficeofTechnologyLicensing(addressgiveninsection8)iftheinventionbecomespubliclydisclosedorpublishedinthefuture(whetherbyplanorinadvertently).  X    Whichofthefollowinghaveyoudoneordoyouintendtodo?       `     h   YES  NO p DATE 8     1. ` Publish   h   ____  ___ p ___________ (     2. ` OralPresentation h   ____  ___ p ___________      3. ` PosterSession h   ____  ___ p ___________      4. ` DisclosetoIndustryRep.  ____  ___ p ___________      5. ` OtherPublicDissemination  ____  ___ p ___________   5.  FinancialSupport/ContractIdentification  p  X    Identifythespecificgrantorcontractnumber(s)(nottheaccountnumber)andtheexternalsponsors(governmentalagencies,industrialsponsors,privateagencies,orothers)whichprovidedsupportusedtodefraycostsrelatedtotheresearchfromwhichtheinventionresulted.Thisinformationisneededtodeterminewhetherthisinventionissubjecttoanycommitmentsorrestrictionsarisingfromthetermsofsponsorship.  X    A.  UniversitySupport: H!!      NOTE:ThepercentagesindicatedinA.andB.belowmustaddupto100%. 8""     1. ` NameandaddressoftheUniversityfacilitywheretheinventionwasdeveloped: $!$ 0   %%      ` Name    h ______________________________________________ %#&      ` Address   h ______________________________________________ &$'      ` City,State,Zip h ______________________________________________ '%(    +@),   0  2.0` %%Pleaseprovidethefollowinginformationregardinganycontractandgrantsupportofthe X inventionprocess.(Pleaseprovidethefollowinginformationforeachcontractorgrantthatsupportedtheinventionprocess;attachadditionalsheetsifnecessary.) ` %` %      ` Name    h ______________________________________________       ` Grant/Contract# h ______________________________________________       ` Address   h ______________________________________________       ` City,State,Zip h ______________________________________________       ` P.I.Name   h ______________________________________________        ` Grant/ContractTitle h ______________________________________________  p       ` Whatwasthepercentageofcontributionthroughthiscontract/grant?_______%0  0%%-,0` %%,-3..0` %%./ /WhatwastheUniversityspercentageofsupportapartfromanycontractsandgrantsto  @  theinventionprocess?_______%(Supportincludesfacilities,personnel,includingyourself,andsuppliesaswellasmoney.) ` %` %   B.   OtherSupport_______% X      ` Pleaseexplainthecircumstancesofthissupport.    C.   Didanyoftheinventorsuseabiological,chemicalorphysicalmaterialorsubstanceobtained      fromotherstocreatethisinvention?YES______NO_______.    IfYES,didaMaterialsTransferAgreementorotherdocumentaccompanythetransfer?    YES_____ NO_____ h Pleaselistanysuchagreements. `     D.   DidyousubmitanyOutsideActivityReportsforthisandthepreviousacademicyear? (# #     YES_____ NO_____ $!$     (Ifyes,pleaseprovidecopiesoftheapprovedOutsideActivitiesReportswiththisinventionπdisclosureform.)  &$'   E.   FORPLANTSDEVELOPEDBYIFASFACULTY:  X     1. ` IsthisplantsubjecttoreviewbyIFASPlantCultivarReleaseCommittee? 8      ` _______YES_______NO     ` IfYES,pleaseprovide:1)  DateofsubmissiontotheCommittee:__________       `     h 2)  CopyofthisformtoyourIFASdean:__________       `     h      p      x ( XXDatesenttoDeanXX  )       ` IfYES,thisinventionmaybesubjecttotheIFASCultivarRoyaltyPolicy. 6.  IDENTIFICATIONOFCONTRIBUTOR(S)   P   X   Listbelowallpersonswhoarebelievedtohavecontributedtotheconceptionorreductiontopracticeofthisinvention.Pleaseprovideaddressesandphonenumberswheretheymaybecontacted.  X  N:XX` hp x (#%'XXXN 򄄀Researcher#1 X   _____________________________   h __________________  _____________________________  8 FirstName   `     h MiddleName   p   LastName ( ______________________________________  _______________________________________________  WorkAddress `     h     HomeAddress  ______________________________________  _______________________________________________  City,State,Zip,Country    h   City,State,Zip,Country p ______________________________________  _______________________________________________ P WorkPhoneNumber `     h   HomePhoneNumber @ N:XX` hp x (#5%'XXNT:XX` hp x (#%'XX5%T______________________________________  _______________________________________________ x  WorkFaxNumber `     h   EMailAddress h ______________________________________  _______________________________________________ H!! SocialSecurityNumber    h   Citizenship 8"" _________________________________________________________________________________________ResearcherTitleandUniversityaffiliation,i.e.,Department,Center,College,Other  %"%    (p&) ЄResearcher#2  __________________________  _________________   p _____________________________  8 FirstName   `    MiddleName     p LastName ( ______________________________________  _______________________________________________  WorkAddress `     h     HomeAddress  ______________________________________  _______________________________________________   City,State,Zip,Country    h   City,State,Zip,Country  p  ______________________________________  _______________________________________________  P  WorkPhoneNumber `     h   HomePhoneNumber  @  N:XX` hp x (#5%'XXNT:XX` hp x (#%'XX5%T______________________________________  _______________________________________________ x  WorkFaxNumber `     h   EMailAddress h ______________________________________  _______________________________________________ H SocialSecurityNumber    h   Citizenship 8 _________________________________________________________________________________________ResearcherTitleandUniversityaffiliation,i.e.,Department,Center,College,Other     ӄResearcher#3  __________________________  _______________   p _____________________________  p FirstName   `    MiddleName     p LastName ` ______________________________________  _______________________________________________ @ WorkAddress `     h     HomeAddress 0 ______________________________________  _______________________________________________ h City,State,Zip,Country    h   City,State,Zip,Country X   ______________________________________  _______________________________________________ 8"" WorkPhoneNumber `     h   HomePhoneNumber (# # ______________________________________  _______________________________________________ %"% WorkFaxNumber `     h   EMailAddress %#& ______________________________________  _______________________________________________ '%( SocialSecurityNumber    h   Citizenship (p&) _________________________________________________________________________________________ResearcherTitleandUniversityaffiliation,i.e.,Department,Center,College,Other +@), Ї  H4XX` hp x (#%XXHNote:Theforegoinglistshouldincludenamesofallpersonswhomayqualifyaslegalinventors.Inventorshipisalegalquestionwhichisgenerallydeterminedbytheattorneyofrecordatthetimeapatentapplicationisfiled.AstatementwhichdiscussestheconceptofinventorshipisavailablefromtheOfficeofTechnologyLicensing.  7.  Signatures       SignatureofInventorsubmittingdisclosure:     ` Signature  __________________________________________  `         ` Date   __________________________________________  @    TheDepartmentChairpersonofeachinventorshouldconfirmtheproportionofUniversity x  contribution,includingpercentagesofcontractandgrantsupport,totheinvention(Seeitem 5).  h        `    (1) h     (2)     x (3) H     Dept.Chair _________________    _________________  ________________ 8         Signature _________________    _________________  ________________      Date `  _________________    _________________________________    TheCollegeDeanofeachinventorshouldconfirmtheproportionofUniversitycontribution,includingpercentagesofcontractandgrantsupport,totheinvention(Seeitem 5).  p        `    (1) h     (2)     x (3) P     CollegeDean _________________    _________________  ________________ @         Signature _________________    _________________  ________________ x      Date `  _________________    _________________________________ X    8.  Distribution  8""   SendtheoriginalandonecopyofthedisclosuretotheOfficeofTechnologyLicensing,Room186    GrinterHall,3928929.  RevisedFebruary1997