ࡱ> Q bjbjXX :2e2e" " ggggg{{{8\\{?5pkk4Y"{ 4444444$7e:4g7"Y4gg40 Rgg4 4 /h1}[jd045<?5z0;K;,h1,1;g1 44?5;" -:  Boston College Tangible Property Disclosure Form The Boston College Intellectual Property Policy defines tangible research property as: research results in their tangible physical form, including biological organisms, compositions of matter, instruments, machines, devices, and other property that can be physically distributed. This disclosure form intends to capture information related to the development of tangible research property which is relevant to its commercialization. 1. Title of Invention:  2. Key Words:  3. Please list all individuals you believe to be inventors : NameInstitutionPositionDepartmentPhone/E-Mail Is Federal Employee?(Y/N)Contribution Percentage (total 100%) 4. Indicate all sources of funding for the invention, including internal funding or funding received from government agencies, nonprofit organizations or commercial entities: Sponsor(s)Contract/Grant No(s).Period of FundingPrincipal Investigator 5. Use of AVо and Third Party Resources: Where and when was the invention first conceived?In generating the invention, did you use any confidential information, materials, equipment, software, facilities, or other items obtained from entities other than Boston College or individuals other than your co-inventors?xCheck as May ApplyYesNoIf so, please give the name(s) of these sources and describe the nature of the item(s): Is there an agreement in place covering the provision of the item(s) to you? If so, please describe. 6. External Disclosure Information: xCheckPlease Provide Dates, Circumstances, Location, etc.Has the invention been described, in whole or in part, in a printed or online publication?YesNoHas a manuscript describing the invention, in whole or in part, been submitted for publication? If so, when?YesNoIf a manuscript has been submitted, has it been accepted for publication? If so, provide the name of journal and anticipated date of publication in print or online.YesNoHas the invention been described in any application for external funding? If so, provide the name of the external organization and the date of application.YesNoHas the invention been disclosed in a public setting such as a poster session, conference, or seminar? If so, when? If not, are any such disclosures scheduled to occur?YesNoHas the invention been disclosed in a private setting, such as a conversation with a company or with colleagues at another institution? If so, please describe.YesNo Invention Description. Please include (or attach) a detailed technical description of the invention, drawings, photos, or other figures that help describe the invention. Include a discussion of available or expected data, and future research directions. Consider: How does the invention differ from existing technologies? Is the invention an improvement to, or a new use of, an existing product or process, and if so, what are its novel features? What are its advantages?  8. Inventors signatures (attach additional table if required): By signing, you agree that: All information provided herein is true and complete to the best of my knowledge. I will do everything reasonably requested by the Boston College Office of Technology Transfer and Licensing to assist in the evaluation, protection and possible commercialization of this invention. If I am an employee or student of, or fellow at, Boston College, I hereby assign all right, title and interest to the invention described herein to Boston College. Print or Type Name:Print or Type Name:Signature and Date:Signature and Date:Home Address:Home Address:Personal Email:Personal Email:Country of Citizenship:Country of Citizenship:Print or Type Name:Print or Type Name:Signature and Date:Signature and Date:Home Address:Home Address:Personal Email:Personal Email:Country of Citizenship:Country of Citizenship: Please note: if your home address changes, it is your responsibility to notify the Boston College Office of Technology Transfer and Licensing, and to provide your current contact information. If not, this could not only delay actions relating to the protection and commercialization, but could also affect your receipt of any royalty checks which may result from the licensing of this invention.      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