Innovation Disclosure Form

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Please complete the form below to disclose your innovation to the University of Minnesota Technology Commercialization office. All fields marked with a * are required. Please fill out every section as completely as possible to the best of your ability. 

If you encounter any issues, contact umotc@umn.edu.

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Leave blank if you have not worked with our office or don’t know


Primary Investigator (PI)
Please fill in details for the PI of this innovation. This person should be affiliated with the University of Minnesota and will be the primary contact for additional information and all correspondence.

Please provide an email address where this contributor could be contacted in the future if UMN affiliation changes



Does this contributor have any joint department or outside appointments (e.g. VA or secondary UMN department)?


UMN Contributors
Please fill in details for all individuals who were affiliated with UMN at the time of invention/development including students, post-docs, and scientists

Please provide an email address where this contributor could be contacted in the future if UMN affiliation changes



Does this contributor have any joint department or outside appointments (e.g. VA or secondary UMN department)?


Non-UMN Contributors
Please fill in details for all individuals who were not affiliated with UMN at the time of invention/development.



Innovation Details

Title must be short, simple and non-confidential

Please select the option(s) from the list that best describes the nature of your innovation

Briefly describe the innovation and attach any drawings, figures, graphs, supporting manuscripts, posters, abstracts, presentation slides, etc. that would assist Tech Comm in understanding the innovation.







Examples - working prototype, beta tested, scripted, in vitro/in vivo data, pre-clinical data, etc.)

If possible, explain what additional development steps would be required to make this innovation ready for commercialization

Public Disclosures

Public Disclosures can impact patent protection. Please share the dates, titles, location, and type (e.g. poster, talk, paper, etc) of any non-confidential presentations, publications or internet postings related to the innovation. Include any hyperlinks if applicable.

If you have a public disclosure happening within the next 30 days, please submit this form immediately and email your TPM or umotc@umn.edu with the subject line "URGENT: Imminent Public Disclosure."

Enter none if there have been no public disclosures related to this innovation

Enter none if there are no planned public disclosures related to this innovation

Funding/Encumbrances
Please provide complete and accurate details regarding the funding and external materials used to develop this innovation. Research sponsors and third parties (e.g., providers of cell lines, datasets, or proprietary software) often hold legal rights that dictate how the resulting intellectual property can be protected or licensed.
Please include all sources of support, such as:
  • Federal Grants: NIH, NSF, USDA, DOD, VA, etc.
  • Non-Federal & Internal Support: Foundations, internal UMN grants, gifts, or departmental funds.
  • Corporate Support: Industry-sponsored research agreements (SRAs).
Important Note on Industry Funding: Corporate/industry funding obligations usually prevent those funds from being mixed (commingled) with federal or other funding sources. If your innovation was developed using a combination of industry funding and any other source, please stop and contact your Technology Portfolio Manager (TPM) or email umotc@umn.edu to discuss your case before submitting this form.


Sponsors




Refer to the NOGA. NIH grant numbers must contain 2 letters and 6 numbers ("0"'s preceding if necessary). Example HL083880. NSF grant numbers must contain 3-4 alpha, "-" (dash), 7 numeric digits, EXAMPLE: DGW-1069104.



Material/SW/Data




List all 3rd party library names in the code



References/Literature

Enter none if you are not aware of any background materials
Commercialization Contacts

Other Information

I certify that the information being submitted is true, complete, and accurate to the best of my knowledge.
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