ࡱ> wyv >lbjbjVV Bq<<"3---8e\-"De{^CCCCCCCErH\CQCCF#F#F#FCF#CF#F#RAAC@_b-. BuCC0"D'BH TH<ACHAC4>,F#$BCC"B"DH :   SIMON FRASER UNIVERSITY Policies and Procedures SUBJECT: INTELLECTUAL PROPERTY POLICY R 30.03 APPENDIX C Intellectual Property Disclosure Form Disclosure of the intent to commercialize any Intellectual Property (IP) subject to this policy is required, via completion and submission of Parts A and B of this Appendix or, for 鶹Ƶfaculty members only, via the annual reporting that is required under Policy A 30.04 on Outside Activities. Commercialization of the IP by 鶹Ƶis not required by Policy. However, full disclosure via completion of all sections of this form will provide an opportunity for the IO to assist Creators to determine the Commercialization potential, whether or not they wish to Commercialize through the University. Since it is in everyones interest to provide the best possible intellectual property protection and/or Commercialization pathway for a new technology, it is important that the details of new IP be documented at an early stage, which (in turn) enables the IO to develop an understanding of the potential market so that the best Commercialization vehicle can be determined. In Part B of this form, there are detailed questions about the IP, prior art, and the potential commercial applications. It may be difficult to provide a full answer for each section at this point, but please do all you can. For many of the questions, it is appropriate to answer using point form format. Please feel free to attach additional pages and/or expand the areas within this MSWord document to meet your needs. The IO staff will also be happy to clarify the information specifically required in each section. Alternatively, you may wish to meet with an IO Technology Manager prior to completing this document; in most cases, this is the route by which the IO prefers to receive disclosures from Creators the IO and the Creator can work together to complete this Disclosure form. Information provided on Part A of this form will be used for statistical purposes and will not be disclosed in any form that will identify the Creator(s) or any aspect of the IP without their written, prior permission. Information provided on Part B of this form will be used to assist with the commercialization of the IP and will not be disclosed in any form that will identify the Creator(s) or any aspect of the IP without their written, prior permission. Any questions can be directed to the IO at our general office number (778) 782-4292 (fax: 778-782-3477), via email to  HYPERLINK "mailto:sfuio@sfu.ca" sfuio@sfu.ca or by contacting an IO staff member directly. APPENDIX C Intellectual Property Disclosure Form PART A As per Section 8.2 of Policy R30.03, a Creator who elects to Commercialize his/her IP must disclose such election in writing, as appropriate, to the Chair/Director of the Department/School (for faculty members see the exception to this in Section 8.3), supervisors (for other employees), or faculty supervisor (for students), who will then forward the information to the Vice-President, Research via the IO. 1. Description of the IP. Please provide a brief and technically accurate title and description of the IP; attach documents, if appropriate. 2. Creator(s). List the names of all Creators and the 鶹Ƶdepartment or external institution with which they are affiliated. If the IP was developed as part of a collaborative R&D partnership with another institution(s) please list accordingly. Include the names of and information on all persons who contributed to the conception and/or made significant developmental modifications to the IP. Please ask the IO for clarification if you are unsure who should be designated as a Creator. Creator A Creator B NamePosition/TitleDepartmentAddress Telephone and FaxEmail and personal web siteContribution of this Creator to the IP % contributionCreators Signature Date of SignaturePlease append additional information if more than two Creators are involved. Acknowledgements of Receipt of this Disclosure NameSignatureDateChair/Director/SupervisorIO Director APPENDIX C Intellectual Property Disclosure Form PART B 1. Why does the Creator believe that the IP has commercial potential? Please describe specifically how this IP may be useful, to whom it would be useful, and of what value it is or may be to, for example, society, science, education, commerce, or technological advancement. 2. What companies or other entities does the Creator see as interested in this technology? Please describe these in terms of generalities or as specific companies or other entities, depending on the particulars of your IP and/or the contact(s) you may have already had regarding the IP. 3. Describe the existing documentation and materials that support this IP. Please attach a full description of the IP to explain what it is and what it will do - in a manner that would enable someone having knowledge in the field to understand the IP and its significance. Identify the advantages of the IP and the elements that are considered novel. Please check the items below to indicate additional materials that are attached/available. Papers Graphs Performance Data Drawings Sketches Reports Photographs Flow Charts Grant Application Prototype Please describe the existing documentation that supports this IP. Does this documentation exist as lab notes, computer records, or in some other form? Has this documentation been progressively collated in a journal, on the computer (or both) or in some other form. Are the records recorded in ink, bound, dated, and witnessed? Where are all the records of the development of the IP kept? Do back-ups exist? 4. Time line of the development of the IP. Please give a brief summary of the steps that led to creation of this IP, the people who were involved, how they contributed (you may wish to identify non-Creators in this section), and the dates on which key events occurred (e.g. conception; major modifications, advancements, or discoveries). 5. Has there been public disclosure of the IP? Yes No Public disclosure includes publications, abstracts, presentations, public seminars, publication of thesis, or disclosure or discussions with others outside the institution (who have not signed a confidentiality agreement). If yes, please provide dates, names and locations and copies of any articles, etc. This can be critical information - dates must be accurate. 6. Are there plans to publish ANY information related to the IP? Please include details if you are planning to publish material on this IP in the near future (where, when, authors, specific topic). This can be critical information - dates must be accurate. 7. How has development of this IP been funded to date? Please provide information regarding any grants or contracts that have been received from any sources external to SFUs budget that have led to the development of the IP. Include the sponsors name, organization, amount of funding, and funding period. 8. Are there any contractual obligations associated with this IP or with the research that led to its development? Please indicate any intellectual property commitments that currently exist or may arise as a result of having received funding, etc. during the course of developing this IP. 9. What is the state of prior art associated with the IP? Have you performed a thorough search of the literature to confirm that your IP is new and unique? Please describe the types of searches you have performed and the results i.e. what you found in terms of patents and/or journal; articles. (Please note that to be able to patent and/or otherwise protect IP, it is key to be reasonably confident that no prior art exists). If prior art exists, what deficiency in the prior art does your IP remedy and/or what limitation does it overcome? 10. What are the greatest impediments to the adoption and/or commercialization of the IP? 11. Is further research or development required to make the IP market-ready? Do you feel that the IP is complete i.e. ready for patenting and/or commercialization as it currently exists? 12. If the IP requires further research or development: a. Is further work currently in progress? b. Please describe the additional steps and/or resources (e.g. time, money, people, other resources, etc.) that will be required to complete the IP and your best estimate of how long this will take. c. Is completing this work dependent on acquiring additional grant monies or commercial funding? Approximately how much funding do you think is required to complete the IP? d. If funding is needed, are efforts currently underway to obtain this funding? If so, please describe. e. Would you consider partnering with another organization (university research institution, company, etc.) to further or complete the development of your IP? 13. 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