QATAR UNIVERSITY
V.1.0
Confidential Intellectual Property Disclosure Form
Patent, Copyright, Trademark and/or Tangible Research Property
This is a confidential, proprietary, nonpublic document that may NOT be communicated in any way
without the consent of the Qatar University Technology Transfer Office. The completed form should be
submitted to the QU Technology Transfer Office.
1. Intellectual Property Title:
2. Contributors: List the names of all Qatar University and any non-Qatar-University personnel who
contributed to this intellectual property. The person whose name appears first will be the contact person with
regard to this intellectual Property. Add rows if needed. Please indicate if any originators are not Qatar
University employees. If not, please indicate their corporate/university affiliation or Qatar University status, if
any, (i.e. Visiting Professor, etc.). Indicate if any of the listed contributors have consulting or other relevant
relationships with entities other than Qatar University? Please explain and attach any consulting agreements
or other relevant contracts. Label these as Attachment A.
Contributor(s) Name(s)
Qatar University
Affiliation & Address
Email Address and
Telephone Number
Home Address
3. Sponsorship. Was the work that led to the Intellectual Property funded by a sponsored program? List all
the funding agencies and programs below.
Funding Agency
Principal Investigators
Award Title
QATAR UNIVERSITY
Office of the Vice President for Research
Account Number
4. Public Disclosures: Publications, Oral Presentations, Posters, Web Postings.
A) List the titles and dates of possible public disclosures of the Intellectual Property. This includes
publications, oral presentations, posters, theses, websites, or speaking to the press or media. Indicate
whether the Intellectual Property was described in specific or general fashion. Include copies of publications,
abstracts of talks, news stories, etc. Label them collectively as Attachment B.
B) Are there planned future publications or public disclosure? YES____ NO_____
If yes please include a date when the publication will be distributed or the date when any public disclosure
such as a talk will take place. Include copies as Attachment C.
5. General Description. Describe the key features of your Intellectual property. Is it a new process,
composition of matter, a new device, or a new use for, an improvement of, an existing product or process, a
software, a drawing, etc.? If the Intellectual property is a composition of matter, a device, or a product, describe
how it is made. If the Intellectual Property is a process, describe the steps that are involved.
6. Utility. What are possible uses or applications of this Intellectual Property? In addition to direct applications,
are there any other uses that might be realized in the future?
7. Novelty. How does this Intellectual Property differ from existing technologies and current practices? What
are its advantages and what problems does it solve?
8. Limitations. What are the disadvantages or limitations of this Intellectual Property? Can these be solved?
How?
9. Experimental Verification. Have you tested the Intellectual Property experimentally, or have you
constructed a prototype or model? YES____ NO_____ If yes, describe below.
10. Prior Art. Are you aware of any inventions or publications by others that are related to this Intellectual
Property? Attach copies of any literature or patent searches that you have done. Include these as Attachment
D.
11. Commercial Market. To the extend known, describe the current and/or potential market for this Intellectual
Property. How do you envision that this Intellectual Property might be used in a commercial product or a
process? Is there a suggested strategy for commercializing this Intellectual Property?
12. Industry Contacts. Please provide the names and contact information for the people with whom the QU
Technology Transfer Office could discuss the commercial possibilities for this Intellectual Property. Mention if
you have already spoken to any of these organizations.
14. Abstract. Provide a brief (less than one page) abstract of the Intellectual Property. Note that this abstract
SHOULD NOT CONTAIN CONFIDENTIAL INFORMATION and is intended for marketing purposes. Therefore,
it could be distributed without a non-disclosure agreement. It is important to include the novel nature of the
Intellectual Property. However, this should not include elements that would allow someone to practice or
reproduce this Intellectual Property.
15. Signatures and Declaration. I hereby declare that all statements made herein of my own knowledge are
true and that all statements made on information and belief are believed to be true.
By signing this form, I understand that I am subject to the Qatar University’s policies, including the University’s
intellectual property policy.
_____________________________
Inventor’s Signature
_____________
Date
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Inventor’s Signature
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Date
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Inventor’s Signature
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Date