UWS Innovation
www.uws.edu.au
Tel: 61 + 02 9685 9742
Bld EH, G.14, Parramatta Campus
Locked Bag 1797
Penrith NSW 2751
CONFIDENTIAL
Intellectual Property Disclosure Form
Please complete the following information as thoroughly as possible, gain Dean/Director of Institute’s
approval and then submit to UWS Innovation at ip@uws.edu.au. If you have any queries please do not
hesitate to call the UWS Innovation team on (02) 9685 9742. The form is designed to help us provide an
improved service to you.
Title of Intellectual Property:
Name of Project Coordinator:
Phone:
Email:
School/Centre:
Dean/Director of Institute:
1. Category of Intellectual Property (more than one may be applicable)
Copyright – text, image etc.
Copyright – source code/algorithm
A new product
An improvement to an existing product/technology
A new technology
A new use for an existing product/technology
A new process
Other category (please specify)
2. Team details (Please use Appendix Sheet if this space is insufficient)
Full Name
1.
2.
School/Centre:
Phone:
Email:
Status (student/staff):
Contribution (%):
Private Address
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Full Name
3.
4.
School/Centre:
Phone:
Email:
Status (student/staff):
Contribution:
Private Address
a) Were any students involved in the project at any stage? Yes
No
If yes, please provide details including student name and dates of participation:
3. Non-confidential abstract (up to 50 words)
Please summarise the key scientific aspects, novelty and benefits/areas of application. This
abstract may be used by UWS Innovation in publications or documents for the IP Evaluation
Panel. This abstract should not disclose any sensitive information about the Intellectual Property
to the public and should be a high level overview .
4. Detailed description (please append sheets if this space is insufficient)
If you have a draft manuscript or publication, this will suffice, otherwise please attach a detailed
description of the Intellectual Property including any relevant manuscripts, sketches, drawings or
photographs to illustrate the concepts.
In addition please complete the following:
a) History of the work:
b) Prime Features – what makes it novel?
c) If the work is software (or a component is), was any open source code used? Yes
No
If yes, please provide details as to what code:
d) Background (status of existing technology and how this distinguishes itself)
e) Utility – list all of the possible uses for the Intellectual Property
f) Please list any of the modifications and improvements that you can foresee
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5. Prior Art
a) Please give details, with references if possible, of patent applications, key scientific literature
and/or public oral communications, both your own and others’, covering the state of the art
prior to the Intellectual Property.
b) To enable a database search please provide a list of key words.
6. Disclosures (eg. public discussions or publications)
Please give details of any disclosures (such as publications, presentations or discussions with
academia or industry) past or more importantly, ones planned for the future, regarding the
Intellectual Property, stating whether they were under confidentiality agreement (please attach
relevant publications). Disclosures not covered under a confidentiality agreement may prevent
patenting.
Type of Disclosure
Confidential
Yes/No
Description or Title
Venue or Occasion, etc
Geographical
location / date
7. Patents
Have you or your school filed, or do you intend to file, any patent applications? Yes
If yes, please give the following details:
No
Patent Agent:
Contact Name:
Phone:
Fax:
Application Number
Priority Date
Country
8. Development Status (please tick appropriate box)
What is the development status of the work?
Projected
Early
Intermediate
Finished
Prototype available
9. Research funding/Grants/Assistance
Please give details of main source for the research generating the Intellectual Property:
Type of funding
✔
Start date
End date
ARC Grant
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N&MRC Grant
Other Grant
Contract
Collaboration
Other
Sponsors
Company Name:
1.
2.
Contact Name:
Phone:
Fax:
Title:
Reference No:
Please give details of any other assistance received including finance, collaborative resources,
equipment, services in kind, special materials and / or know-how.
10. Commercial application and value
a) Have there been any attempts to commercialise this Intellectual Property? Yes
If yes, please give details:
No
b) Please indicate, if you feel able, what you see as the commercial application and value in
your invention and suggest, if possible, a final product.
11. Competing products
Do you know of any competing products, Intellectual Property or ideas on the market?
Yes
No
If yes, please identify them/their manufacturer:
Do these work on a principal which is similar or dissimilar to your work described above? Why is
yours superior?
12. Potential collaborators/licensees
What kind of company do you think would be interested in a license?
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Can you suggest any countries or specific companies we should include when marketing this?
(please include a personal contact and a job title if you have one)
Does the Intellectual Property involve the use of technology licensed from a third party or
protected by confidentiality agreements? Yes
No
13. Other information
Forms can be unintentionally restrictive. Is there any other information which we should have on
record concerning your work? If so, please attach as described below:
14. Attachment List:
Signature:
Date:
Project Cooridinator :
______________________________________
___________
Dean/Director of School/
Institute:
______________________________________
___________
NB: Following a preliminary evaluation by the UWS IP Manager, if your work is considered of commercial interest to the
University, you will be asked and assisted to present this at the next available IP Evaluation panel for further assessment.
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