SFU Innovation Office
Invention Disclosure Form
INSTRUCTIONS
Upon disclosure of a new invention, the Innovation Office conducts a thorough due diligence
assessment to determine commercial potential and assess potential for humanitarian benefits.
This process focuses primarily on market potential and strategies for protection of intellectual
property. In order to assess your Invention, the Innovation Office requires detailed information
from the inventors about (1) the nature of the invention, (2) its development history, and (3)
the commercial applications, products and/or services that may arise from the invention.
Complete information is required in order to proceed with our evaluation process. Please
complete all sections of this form to the best of your ability and knowledge. You will be
contacted within 14 days for an initial discussion on the disclosure. A decision to accept or
decline an invention for commercialization assistance by SFU will be provided within 60 days of
receiving the required information.
If you have any questions, please contact us for assistance (email: sfuio@sfu.ca; telephone:
778-782-4292).
Please submit your form as an electronic file (MS Word format) attached to an email to
sfuio@sfu.ca. If you have already been in discussion with one of the Innovation Office team
members, please provide the name of the person you have been in contact with.
SFU Innovation Office
Invention Disclosure Form
CONFIDENTIALITY NOTE: This document is intended only for the Simon Fraser University Innovation Office and may contain
information that is confidential, legally privileged, or exempt from disclosure under applicable law. If you are not the intended
recipient, or an individual responsible for delivering messages to the intended recipient, you are hereby notified that any
dissemination, distribution or duplication of any portion of this message is prohibited. If you have received this document in
error, please notify one of the individuals listed in Section 1 immediately.
1. Inventor Information
Provide the following information for, and signatures of, any and all of the individuals who have
made inventive contributions to this invention. The inventor who will be the primary contact
should be listed as Inventor A.
Inventor A
Last name:
First name:
MI:
Position/title:
Department/school:
Citizenship:
Home address:
Work telephone:
Home telephone:
Email:
Description of inventive contribution:
% contribution to invention:
Signature:
Date (MM/DD/YYYY):
Inventor B
Last name:
First name:
MI:
Position/title:
Department/school:
Citizenship:
Home address:
Work telephone:
Home telephone:
Email:
Description of inventive contribution:
% contribution to invention:
Signature:
Date (MM/DD/YYYY):
SFU Innovation Office
Invention Disclosure Form
Inventor C
Last name:
First name:
MI:
Position/title:
Department/school:
Citizenship:
Home address:
Work telephone:
Home telephone:
Email:
Description of inventive contribution:
% contribution to invention:
Signature:
Date (MM/DD/YYYY):
Inventor D
Last name:
First name:
MI:
Position/title:
Department/school:
Citizenship:
Home address:
Work telephone:
Home telephone:
Email:
Description of inventive contribution:
% contribution to invention:
Signature:
Date (MM/DD/YYYY):
SFU Innovation Office
Invention Disclosure Form
2. General Information
Title of invention: Provide a short, descriptive title (max. 100 characters)
Keywords: Provide a list of keywords to be used for patent, literature and product searches.
Please provide both broad and narrow search terms.
Please identify the SFU department(s) where the invention was developed:
Is the invention the result of a collaborative project involving another institution,
organization or company?
If yes, please complete the following information:
Institution/organization/company name:
Institution/organization/company location:
Contact name:
Contact telephone:
Contact email:
List the sources of funding that have been used for the development of this invention: This
may include grants, university or departmental support, private funding, etc.
Name of source
Amount ($)
Start Date
(MM/DD/YYYY)
End date
(MM/DD/YYYY)
SFU Innovation Office
Invention Disclosure Form
3. About the Invention
Describe the primary commercial problem(s), opportunities, or unmet needs your invention is
intended to address (i.e. the problem(s) it is currently geared towards):
Describe any additional areas in which your invention could be applied (i.e. secondary
applications):
Provide a detailed description of the invention, including the individual parts/steps that
comprise it: If you have any sketches, diagrams, pictures, technical documents, etc. that will
help describe the invention, please reference them here and attach them as separate
documents.
Explain how your invention addresses the commercial problems described above:
Describe any test/experimental results that demonstrate the performance of the invention,
as well as any prototypes/test beds/etc. that may exist:
Describe the developmental history of the invention:
Describe the developmental steps that still need to be completed before the invention can
become commercially available:
Provide a rough development plan for this invention, including experimental goals/strategies
and timelines:
SFU Innovation Office
Invention Disclosure Form
Identify any risks/barriers to completing the remaining work:
Indicate any possible sources of funding that you have identified for advancing the
development of the invention:
If you have any additional scientific support documents that may assist us in the evaluation of
this invention, provide a list here and attach the documents separately: These documents
could include yours or others’ research or review articles (published or manuscripts), lab
documents, demonstration records, presentations, abstracts, etc.
Type of document
(e.g. journal article)
Title
Brief description of how it relates
4. Market Evaluation
List and describe the commercial products/processes/services that your invention will
compete with, highlighting the advantages of your invention over the competing
technologies: If there are no competing solutions, describe how the market currently addresses
the problem that your invention aims to solve.
List who you consider to be the principal competitors in the general field of this invention (e.g.
academic research groups, companies and other industrial organizations):
SFU Innovation Office
Invention Disclosure Form
List any companies, organizations or research groups that are, or could be, interested in
collaborating in R&D or commercialization of this invention: Include details for any contacts
you have at these companies.
Company/organization/
research group
Contact info
Brief description of the nature of the collaboration
List any entrepreneurs you know who are, or who may be, interested in assisting with the
commercialization of this invention:
Entrepreneur name
Contact info
Brief description of the nature of their interest
5. Use of Proprietary Materials
If any part of the invention is based on, or was made possible by the use of, proprietary
materials or techniques obtained from a third party (e.g. company, other institution, other
research group), list these here: This should include proprietary materials made available
through industry-sponsored research agreements, software licenses, material transfer
agreements (MTAs), etc. Examples include cell lines, DNA, research animals, compounds,
software or algorithms written by others, open source software, etc.
SFU Innovation Office
Invention Disclosure Form
6. Public Disclosures
Public disclosures may include publications (electronic or paper), oral or poster presentations,
presentation slides, graduate theses, news articles, abstracts, seminars, websites,
demonstrations, etc.
Prior disclosures:
Date
(MM/DD/YYYY)
Type
Description/Purpose
Planned disclosures:
Date
(MM/DD/YYYY)
Type
Description/Purpose
Disclosed
under
confidentiality
agreement
SFU Innovation Office
Invention Disclosure Form
7. Prior Art
Have any patent or literature searches been conducted?
If so, how exhaustive were they, and what keywords/search terms were used?
Please provide a list of any known and potentially relevant prior art documents
(patents/patent applications, journal articles, websites, news articles, conference
presentations, etc.) that may have resulted from these or other searches: If additional space is
needed, include a separate attachment.
Document
Description of related aspects