Grants Registration


	HOME

SCIENCE/PROFESSIONALS

Research Grants

Grants Information

Grants in Force

Professional Education

Medline

Society Research & Researchers

	THE SOCIETY


	Grant Application System


Patent Invention Submission

Back

Use this online form to complete your patent/invention disclosure information. This session will be active for a total of one hour in order to allow you to complete this form. If your session is disconnected or the form is not completed within one hour, you will need to begin the form again.
Once the online form is complete select the �Submit to Society� link to submit this form to the Society. The Society will then email a copy of your submission as a PDF file to the email address specified in the preparer (Certifying Official) information section of the form.
Once the Certifying Official receives the email, they should print and sign the completed patent/invention disclosure form.
Mail the completed and signed form to the Director of Research Administration at the address specified on the Grant Reporting and Requests page.

You have seconds until you lose your connection.

Patent/Invention Profile (Grantee Information)

Society Grant #:	(Ex. R6215-02 or 1234-05)
Grant Recipient:
Sponsoring Institution:

Reporting Period (e.g. 10/01/2002)		To:
Grant Period (e.g. 10/01/2002)		To:

1. Have any Discoveries, inventions or improvements, patentable or unpatentable been conceived or reduced to practices in the performance or research funded in whole or in part by the Society? If Yes, attach a description of the discovery in the attachment field below.	No	Yes
2. Have any patent/invention applications been filed or are any in the process of being filed as a result of the research funded by the Society grant? If yes, attach copies of all information concerning any patent/inventions or application for patents related to this project in the attachment field below.	No	Yes
3. Have any other legal protection been sought for intellectual property conceived of or developed in the performance of research funded in whole or in part by the Society? If yes, attach copies of all information concerning any applications for intellectual property projection in the attachment field below	No	Yes
4. Have any agreements been reached with third parties to commercialize or otherwise use the patent filed above? If yes, attach copies of all information concerning commercial agreements in the attachment field below.	No	Yes

For each affirmative response to the questions above, combine the required information into a single document and attach the file in the field below.

Add any comments related to the patent report

Preparer Information (Certifying Official)

By checking the preceding check box and submitting this report to the Society, I certify that I am authorized to submit and I fully understand the information disclosed in this report.

First & Last Name:
Institution:
Street Address and Secondary Address Information if necessary

	City	State	Zip Code

Country

Telephone:		Ext:
Fax:
Email:

Back

last updated on 06/24/03

Need Help? Contact us by email or call (914) 821-8843