Invention Disclosure Form

Please complete the following question.

INTELLECTUAL PROPERTY REPORT FORM

Who contributed to this Intellectual Property?
Please list any individuals who made a material contribution, as well as their affiliation (i.e. Birck, Bindley, ARS, IDI, CERIAS, etc). If they are a non-Purdue employee, please provide appropriate contact information. (*see at the end of the form for additional space if more than two contributors)
Please provide a technical description of what the IP is and how it works. If you have a manuscript, research proposal, grant, etc. describing the IP please include a copy, even if it is a preliminary draft.
Is there external support for the work leading to this invention (NSF, DOE, DOD, Hatch, corporate, etc.)? If so, what is the entity, grant number, termination date?

Upon successful submission of this report, OTC will contact our to arrange a meeting.