Case No. (Monash Innovation use only)
Invention Disclosure Form
WS
Complete this form and send to [email protected] (T: 03 9905 3088).
If you have already initiated a discussion with your Faculty Industry Engagement Team or with Monash Innovation,
please copy the email to them and provide their name(s): _______________________________________________
Position
External
Inventor(s)
Student
1. INVENTORS
An inventor is an individual without whose intellectual and creative input the invention could not have been made in its
present form. They must have conceived or contributed an essential element of the invention, either independently or
jointly with others, during the evolution of the invention or its reduction to practice. Co-authors of publications are not
necessarily inventors. If you are unsure whether an individual is an inventor, please list details but prefix with a question
mark. If the inventor also had an external appointment at the time of the invention, please indicate. Add rows if needed.
List all inventors and their position at the time of the invention. Nominate one person as the main contact.
Department
Phone / Fax
Email
2. INVENTION
Title - brief and descriptive,
to aid in identifying the
invention (~6 words)
Date the inventor(s) devised
the essential concepts of the
invention
How is this documented?
In whose laboratory
notebook(s) is experimental
data recorded?
What is the current state of
Idea
Proven concept
Working prototype
the invention?
Attach a document that includes:
 a brief description of the invention
 key features
 the closest known technology and reasons your invention is better
 how you envisage your invention could be used
Also attach any relevant manuscript drafts, presentations, drawings etc.
3. DISCLOSURES
In most countries a patent application must be filed before any oral, online or printed disclosure / publication is made
available externally to the university (unless under cover of a confidentiality agreement). Contact us if you are unsure.
Have any details of any of your research been disclosed publicly? Provide brief details.
In a journal (online or in print):
At a conference or seminar, as a publication, abstract, poster, etc. (including online before the conference):
In a PhD, Master’s thesis or project write up:
In any other online or commercial discussion:
Are there any publications or
disclosures of your research
planned? If so, when, where
and in what form?
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November 2016
Case No. (Monash Innovation use only)
Invention Disclosure Form
WS
4. PRIOR ART SEARCH
Please do an on-line search (1) for publications or products that are closely related to your work and (2) for patents using
www.freepatentsonline.com/search.html (use Quick Search on Title and Abstract; select both US and the WIPO options
below). Please list keywords used and results obtained. Also explain how your invention differs from each
article/item identified.
5. INDUSTRY ENGAGEMENT / COMMERCIALISATION
List any companies you think may be interested in the work or are active in the area. If possible please give contact
information (we’ll consult you before we get in touch with them).
6. SPONSORSHIP OF THE RESEARCH
Was the invention developed using any
research grants / contract funds?
Contract
Sponsor(s)
Is the invention subject to any other
agreements (e.g. material transfer agreement,
consultancy, confidentiality agreement)?
Yes
No
If Yes, please provide details below.
Project title /
Contract number
Yes
No
Principal investigator
Date started
If Yes, please provide details below.
7. SHARE OF INCOME and SIGNATURES
Please have all available inventors fill in details below. For anyone who is unavailable, fill in their name and leave other
details blank - we will obtain details subsequently. Please add additional signature boxes as needed.
We would like to distribute the inventors’ share of any resulting income as follows:
Equally
Other (give details):
By signing below I confirm that: to the best of my knowledge the information given in the form and
attachments is correct and accurate, and all inventors have been named.
Print name:
Print name:
Inventor’s signature:
Inventor’s signature:
Date:
Date:
Citizenship (needed for patent filing):
Citizenship (needed for patent filing):
Print name:
Print name:
Inventor’s signature:
Inventor’s signature:
Date:
Date:
Citizenship (needed for patent filing):
Citizenship (needed for patent filing):
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November 2016