This form is used to disclose new plant varieties/germplasm and to meet obligations of disclosure as required under TAMUS Policy 17.01. Before completing this form, please refer to the guidelines at the end of this document. Please send your completed form, breeder/contributor data sheet(s), and any additional
documentation to disclosures@tamus.edu
.
1.
Plant Variety Name and Experimental Number:
2.
Crop Type:
3.
Genus/species:
4.
Primary Breeder: Department/Unit:
5.
Additional Contributors: (Breeder/Contributor Data Sheet required for each
contributor):
Name: Department/Unit:
Name:
Name:
Department/Unit:
Department/Unit:
Name: Department/Unit:
6.
Funding. Rights in plant varieties/germplasm may be impacted by, or obligated under, the terms of agreements with entities that provided the funding that led to its development. Examples of entities that provide funding under agreements include, but are not limited to, federal agencies, state agencies, non-profit research foundations, commodity boards, private companies, industry associations or organizations, and providers of gift contributions. a.
If no funding provided under a funding agreement was used to develop this plant variety/germplasm, please indicate so by checking this box and proceed to question 7. Otherwise, proceed to 6b.
1
TTC USE ONLY
PV #
______________
Form Revised 07/17/2013

Plant Variety/Germplasm Disclosure Form b.
Please list all sources of funding used in the conception and development of the disclosed plant variety/germplasm; include numbers or other unique assigned identifiers for each.
Name of Funding
Agency/Entity
Federal Grant /
Agreement
/ Contract / or Other
Type of Award No.
Internal Acct. No. or
Other Type of Internal
Reference No.
Contracts &
Grants Office managing award
(e.g. AgriLife,
TAMU, TAMRF,
TEES, etc.)
7.
Has the variety/germplasm been sold or offered for sale to a third party?
Yes No
If “Yes,” please specify the date and circumstances.
8.
Is Foundation Seed being produced by TFSS? Yes No
9.
Is any component of the variety/germplasm owned by a third party?
Yes No
If “Yes,” please identify and describe:
10.
Is this variety/germplasm a genetically modified plant? Yes No
If “Yes,” please provide further detail:
11.
Has the variety/germplasm been approved for release by PRC? Yes No
If “No,” please explain:
12.
Provide attachment containing a complete description of the plant variety or germplasm (including origin and breeding history, objective description, and trial data). If available, please attach a copy of your Plant Release Proposal to meet this requirement. If in preliminary stages, provide brief description and summary of your
tests to date.

Plant Variety/Germplasm Disclosure Form
Please complete the Breeder/Contributor Data Sheet for each person named in questions 4 and
5 of the Plant Variety/Germplasm Disclosure Form. Additional forms can be found at the TTC website at http://techtransfer.tamus.edu
. Please return the completed Breeder/Contributor
Data Sheet to disclosures@tamus.edu
.
Breeder/Contributor Name:
First: MI: Last:
Preferred Salutation: Professor Dr. Ms. Mrs. Mr. Other
PhD DVM MD MS/MA BS/BA Other:
University ID Number (UIN):
Country of Citizenship:
Work Address: Home Address: street address city/state/zip phone fax street address city/state/zip phone fax work email home email
TAMU System Employment Status/Title (including former employees):
Professor Associate Professor Assistant Professor Employed Student
Other Status/Title (if not listed above):
Former Texas A&M University System Employee
If you checked “Former Texas A&M University System Employee,” were you employed by the
A&M System at the time of development? YES NO
System Component: (AgriLife, TAMU, TEES, TTI, Kingsville, Corpus Christi, etc.):
Department/Division:
Laboratory or Center:
Non-TAMU System Employment Status/Title (for non-System inventors only):
Please provide your Position/Title and Company Name:
Form Revised 07/17/2013
3

Plant Variety/Germplasm Disclosure Form
 Please use this form to provide detailed information regarding your new plant variety or germplasm. This form may be completed before or after submission of a Plant Release
Proposal to the Texas A&M AgriLife Research Plant Review Committee (PRC).
 All contributors that should share in royalty income must be identified in questions 4 and 5. A Breeder/Contributor Data Sheet must be completed and submitted with the disclosure form for each breeder/contributor.
 Return the completed disclosure form and data sheet(s) to disclosures@tamus.edu
. For any questions regarding your plant/germplasm disclosure, please contact Janie Hurley at:
Janie Hurley,
Licensing Manager
Texas A&M System Technology Commercialization
3369 TAMU / College Station, TX 77843-3369
Fax: (979) 845-1402 jhurley@tamus.edu
 You may request the “Distribution of Licensing Income” form from our office at the time of your submission to include percentages and signatures from all contributors. If not requested at the time of submission, the Primary Breeder identified in question 4 will be contacted and provided the form to be completed. No royalty distributions can be made until the “Distribution of Licensing Income” form is completed and all breeder/contributors have signed it.