Visiting Scientist/Scholar IP Policy Acceptance Agreement
The Feinstein Institute for Medical Research
North Shore-Long Island Jewish Health System, Inc.
Name of Visiting Scientist/Scholar:
Name of Visiting Scientist/Scholar’s
Home Institution/Company:
Name of North Shore-LIJ/Feinstein facility
where Visiting Scientist/Scholar will work:
Anticipated period of time
at North Shore-LIJ/Feinstein facility:
through
Name of North Shore-LIJ/Feinstein
Faculty Sponsor:
Name of North Shore-LIJ/Feinstein
Business Unit and Department/Lab:
In consideration of being permitted to perform research as a Visiting Scientist/Scholar at North
Shore-Long Island Jewish Health System, Inc. (“the Health System”) and/or The Feinstein Institute for
Medical Research (“Institute”), and to use Health System/Institute facilities and resources, I hereby agree
as follows:
1. I confirm that I have read the Policy on Intellectual Property, North Shore-Long Island Jewish
Health System, Inc., The Feinstein Institute for Medical Research, Amended as of 7/11/2006 (“the IP
Policy”) (copy attached as Exhibit A).
2. I agree that, as a Visiting Scientist/Scholar at the Health System/Institute, I shall be deemed an
employee of the Health System/Institute for purposes of the IP Policy, regardless of whether I am, in fact,
an employee of the Health System/Institute. Without limiting the generality of the foregoing, in
accordance with the IP Policy:
a. I shall promptly disclose in writing and in reasonable detail, to Institute’s Office of Technology
Transfer, any “Inventions”, as that term is defined in Article 1 of the IP Policy, that I make.
Further, I shall fully cooperate with Institute’s Office of Technology Transfer in the preparation
and prosecution of any and all patent applications on such Inventions.
b. I hereby assign to Institute all of my right, title and interest in and to any and all Inventions.
c.
I hereby assign to Institute all of my right, title and interest in and to any and all copyrightable
material that I create as a Visiting Scientist/Scholar at the Health System/Institute.
d. I hereby acknowledge and confirm my obligation not to disclose and to maintain the
confidentiality of any and all confidential or proprietary information and materials of the Health
System and/or Institute, with particular attention to the need for confidential treatment of:
(i) the unpublished data, observations, methods and materials from my own research
programs and those of my Institute and Health System colleagues;
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(ii) the confidential information and materials of third parties that are entrusted to Institute, to
the Health System or to me; and,
(iii) any “Protected Health Information” (sensu the Health Insurance Portability and
Accountability Act of 1996 (“HIPAA”) and the regulations, laws and guidelines related
thereto), medical record or other patient or research subject information that may be
disclosed to or observed by me.
Further, I acknowledge and confirm my obligation to protect such confidential information and
materials from disclosure to third parties and to use the same only as specifically permitted.
VISITING SCIENTIST
Signature
Date
Printed/Typed Name
AUTHORIZED OFFICIAL for VISITING SCIENTIST/SCHOLAR’S HOME INSTITUTION/COMPANY
Signature
Date
Printed/Typed Name
Title
AUTHORIZED OFFICIAL for THE HEALTH SYSTEM/INSTITUTE
Signature
Date
Printed/Typed Name
Title
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