Rensselaer Polytechnic Institute

Invention Disclosure Form


Today’s Date

LEAD CONTRIBUTOR

Non-RPI Contributors Only

Add remaining Contributors at the end of the Invention Disclosure Form.


Please email a full invention description, placing the invention title in the subject line, to: otc@rpi.edu


Use a brief descriptive title to aid in identifying the technology


3. DATE OF CONCEPTION AND PUBLIC DISCLOSURE

**If you have used Gov’t Funding for this invention, and you have already publicly disclosed, please send a copy of the publication to: otc@rpi.edu

Do you intend to disclose the invention publicly in the near future?

*If you are planning to publicly disclose in the next 14 days, please contact Sherri Dente via email: dentes2@rpi.edu.
Public disclosure of an invention prior to filing a patent application can adversely affect patent rights.


4. FUNDING INFORMATION

Please identify all agencies, organizations, or companies that provided funding to the research that led to the conception of the invention. Obligations of the research sponsor(s) will have to be met if patent protection and/or licensing of the technology is pursued.

5. COMMERCIALIZATION and ENTREPRENEURSHIP


6. SIGNATURE THRUST AND KEYWORDS

Enter Keywords under the Signature Thrust(s) that is/are associated to your invention.


7. SOFTWARE DEVELOPMENT

Please attach copies of the fully-signed confidentiality agreement(s).


8. CONTRIBUTOR INFORMATION

Contributors - An inventor, creator, or contributor, as used herein, is an individual who has conceived or provided an essential element of the invention, either independently or jointly with others, during the evolution of the technology concept or its reduction to practice.

CONTRIBUTOR 2

Non-RPI Contributors Only


CONTRIBUTOR 3

Non-RPI Contributors Only


CONTRIBUTOR 4

Non-RPI Contributors Only


CONTRIBUTOR 5

Non-RPI Contributors Only


CONTRIBUTOR 6

Non-RPI Contributors Only


CONTRIBUTOR 7

Non-RPI Contributors Only


CONTRIBUTOR 8

Non-RPI Contributors Only