INVENTION DISCLOSURE FORM
AARHUS UNIVERSITY / CENTRAL DENMARK REGION
The completed Invention Disclosure Form must be e-mailed to [email protected]
The inventor(s) will receive confirmation of received disclosure.
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INVENTION DISCLOSURE FORM
1. TITLE OF INVENTION
2. DESCRIPTION
Describe the invention in brief – approx.1500 characters. (If relevant attach additional information)
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3. DEVELOPMENT STAGE
3a. State the invention’s current development stage; in vitro data, in vivo data, clinical data, proof-of-concept, prototypes,
theoretical concept etc. (Technology Readiness Level – TRL level: 1-9 - Link)
3b. Which studies, prototypes, animal experiments etc. have been conducted that proves the invention’s applicability?
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INVENTION DISCLOSURE FORM
4. COMMERCIAL ASPECTS
4a. Explain in detail what problem(s) your invention solves.
4b. What are the current stand solution(s) to the problem, if any?
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4c. Who are the end-users?
4d. List if you have any ideas to which specific companies/partners could be interested in exploiting the invention.
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4e. How can the applicability, utility and/or commercial potential of the invention be further documented through additional
research studies?
4f. What is the timeframe of such studies?
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INVENTION DISCLOSURE FORM
5. ASSOCIATED RESEARCH
5a. Identify (if any) which research project has lead to the invention and the collaboration partners taking part herein.
5b. List (if any) research funding associated to the invention. Please state all parties involved in the research.
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6. RELEVANT EXISTING TECHNOLOGY
6a. List if possible knowledge of existing technology, patents, publications, articles etc.
(both your own as well as competing research/commercial solutions)
7. CONFIDENTIALITY
7a. Has the invention remained confidential? Any planned publication or PhD defence?
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INVENTION DISCLOSURE FORM
8. DOCUMENTATION
8a. When was the invention conceived?
8b. Describe where and how the invention is documented.
Laboratory records
Computer files
Correspondence
No documentation other than this ID form
Other documentation
9. INVENTOR(S) CONTRIBUTION:
Note: A person’s status as an inventor is assessed based on the extent to which the person in question has made an original,
significant, intellectual contribution during the conception of the actual invention.
9a. List all inventors by name and the current understanding of the proportional % contribution to the invention.
(internal AU and CDR and external parties, incl. master students)
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INVENTION DISCLOSURE FORM
10. SIGNATURE(S) OF THE INVENTOR(S):
The undersigned hereby confirm(s) the above information to be correct. Further as employee of AU/CDR, I/we have hereby
assumed a duty not to make public or exercise any rights over the invention for two (2) months from AU Corporate Relations
and Technology Transfer’s date for receiving this Invention Disclosure Form, cf. the Danish Act on Inventions at Public Research
Institutions, Section 11 (2).
Nationality and private address(es) are required by the patent authorities when a patent application is submitted, so please
make sure to complete this information as well.
SIGNATURES REQUIRED! (Scanned version is sufficient)
Name of inventor (1)
Employer
AU
Central Denmark Region
AU/CDR
AU
Central Denmark Region
AU/CDR
External:
Position
Department/hospital unit/etc.
Nationality
E-mail address
Phone no. at work
Private address
Danish CPR No.
Date and signature
Name of inventor (2)
Employer
External:
Position
Department/hospital unit/etc.
Nationality
E-mail address
Phone no. at work
Private address
Danish CPR No.
Date and signature
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INVENTION DISCLOSURE FORM
Name of inventor (3)
Employer
AU
Central Denmark Region
AU/CDR
AU
Central Denmark Region
AU/CDR
External:
Position
Department/hospital unit/etc.
Nationality
E-mail address
Phone no. at work
Private address
Danish CPR No.
Date and signature
Name of inventor (4)
Employer
External:
Position
Department/hospital unit/etc.
Nationality
E-mail address
Phone no. at work
Private address
Danish CPR No.
Date and signature
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Name of inventor (5)
Employer
AU
External:
Position
Department/hospital unit/etc.
Nationality
E-mail address
Phone no. at work
Private address
Danish CPR No.
Date and signature
Central Denmark Region
AU/CDR