ࡱ>  rbjbjss lU     $111141),.98qqqqPB!`+++++++W-/+ 5%LP5%5%+  qq+3(3(3(5% q q+3(5%+3(3(`**qc1?%^x*++0),*,0%,0*0 *X^#L#63(#, $)^#^#^#++'j^#^#^#),5%5%5%5%0^#^#^#^#^#^#^#^#^# : The University of Akron DISCLOSURE OF INVENTION FORM Date:  FORMTEXT       Disclosure No.:  FORMTEXT       (University to provide) 1. Name and mailing address of individual submitting Disclosure:  FORMTEXT       FORMTEXT  2. Official title or position of submitter:  FORMTEXT       3. Business telephone number of submitter:  FORMTEXT       4. Title or brief description of the invention:  FORMTEXT       5. Grant Award or Contract Number under which the work was done leading to the invention:  FORMTEXT       6. Specify if the invention resulted from: (a)  FORMCHECKBOX  University-supported effort (b)  FORMCHECKBOX  Independent effort (c)  FORMCHECKBOX  Outside activity/consulting agreement work 7. Name and address of the facility within the University at which the invention was made.  FORMTEXT       8. If 6(b) and/or 6(c) above were checked, state the name and address of the facility at which the invention was made.  FORMTEXT       9. If 6(c) above was checked, provide pertinent Outside Activity Report form. 10. If 6(c) above was checked, provide a copy of the Consulting Agreement applicable to such invention as disclosed. 11. Contributions (a) Full name (including full middle name), home address, and citizenship of those who contributed to the initial concept. Name  FORMTEXT       Citizen of  FORMTEXT       Address  FORMTEXT       Name  FORMTEXT       Citizen of  FORMTEXT       Address  FORMTEXT       Name  FORMTEXT       Citizen of  FORMTEXT       Address  FORMTEXT       (b) Full name (including full middle name), home address, and citizenship of those who contributed to subsequent development and testing. Name  FORMTEXT       Citizen of  FORMTEXT       Address  FORMTEXT       Name  FORMTEXT       Citizen of  FORMTEXT       Address  FORMTEXT       Name  FORMTEXT       Citizen of  FORMTEXT       Address  FORMTEXT       12. Conception of Discovery or Invention (a) What was the problem and how did you attack it?  FORMTEXT       (b) First oral disclosure Date  FORMTEXT       To whom  FORMTEXT       (c) First drawings. Date  FORMTEXT       Dwg. numbers.  FORMTEXT       * attach two copies of the drawings to this form (d) First written description: Date  FORMTEXT       Shown to or read by whom  FORMTEXT       * attach two copies of the written description to this form 13. Development of invention (a) Date work on development begun  FORMTEXT       (b) Date completed  FORMTEXT       (c) By whom made?  FORMTEXT       (d) Experimental model  FORMCHECKBOX  Prototype  FORMCHECKBOX  14. First successful test or operation (a) Date of first successful test or operation  FORMTEXT       (b) By whom was the test conducted?  FORMTEXT       (c) Where are the records of the test?  FORMTEXT       (d) Who witnessed the records of the test?  FORMTEXT       15. First disclosure OUTSIDE the University (a) Was the discovery disclosed to anyone outside the University or published in any manner? Yes  FORMCHECKBOX  No  FORMCHECKBOX  (b) Dates  FORMTEXT       (c) To whom made?  FORMTEXT       (d) Where was the disclosure made? (provide details)  FORMTEXT       16. First Commercial Use or Sale (a) Was the invention used, given, or advertised for sale or sold to anyone outside the University? Yes  FORMCHECKBOX  No  FORMCHECKBOX  (b) Dates  FORMTEXT       (c) Please give details of the use, sale or offer for sale.  FORMTEXT       17. Description of Discovery It is essential to include: background information on the purpose of the discovery (i.e., the problem to be solved); and a detailed description of the discovery or invention (i.e., the solution to the problem) with drawings where possible; and a discussion of the advantages of the discovery or invention over what was done before. Be certain to describe the best way of practicing the discovery or invention, and the alternatives to the best way without losing the advantages of the discovery or invention. Attach additional pages if necessary.  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Most Closely Related Prior Publications, Prior Patents, and Prior Products or Uses  FORMTEXT       19. Signature of Contributor(s): (1) _______________________________________________ Date ______________________ (2) _______________________________________________ Date ______________________ (3) _______________________________________________ Date ______________________ (4) _______________________________________________ Date ______________________ (5) _______________________________________________ Date ______________________ (6) _______________________________________________ Date ______________________ The foregoing Invention Disclosure consisting of  FORMTEXT       pages (attached) plus attachments was read and understood by me on the date opposite my name. Witness(es): Include Dean and/or Chair. (1) _______________________________________________ Date ______________________ (2) _______________________________________________ Date ______________________ 20. Please indicate if your invention falls under any or the following categories:  FORMCHECKBOX  01 Agricultural chemical (fertilizers, pesticides)  FORMCHECKBOX  02 Computers, data transmission, communications  FORMCHECKBOX  03 Drugs (human and animal medicinal products)  FORMCHECKBOX  04 Electrical and electronic equipment (transmission, industrial apparatus; household appliances; security, safety and warning alarms; video and sound reproduction)  FORMCHECKBOX  05 Energy (generation, distribution, and controls)  FORMCHECKBOX  06 Food products and processing  FORMCHECKBOX  07 Industrial inorganic chemical products and processing  FORMCHECKBOX  08 Industrial organic chemical products and processing (synthetic, coal, bio- and petro-chemicals)  FORMCHECKBOX  09 Instruments, devices, controls, and systems  FORMCHECKBOX  10 Mechanical machinery and equipment (construction, manufacturing, air conditioning, heat exchangers, vending machines, tools)  FORMCHECKBOX  11 Medical, surgical, dental instruments (devices and supplies)  FORMCHECKBOX  12 Metals (smelting, refining, steelmaking, processing)  FORMCHECKBOX  13 Mining and extraction (minerals, metals, coal, gas, oil)  FORMCHECKBOX  14 Packaging, graphics, printing  FORMCHECKBOX  15 Paints, varnishes, coatings, adhesives  FORMCHECKBOX  16 Petroleum refining, products, and processing  FORMCHECKBOX  17 Photographic devices, optical instruments, and lenses  FORMCHECKBOX  18 Plastics (resins, processes, equipment)  FORMCHECKBOX  19 Pollution controls (gas, liquid, solid)  FORMCHECKBOX  20 Pulp and paper, wood products, and processing  FORMCHECKBOX  21 Rubber and plastic products, and processing  FORMCHECKBOX  22 Soaps, detergents, cosmetics, toiletries  FORMCHECKBOX  23 Stone, glass, clay products, and processing  FORMCHECKBOX  24 Synthetic fibers (fiber production, processing, raw materials)  FORMCHECKBOX  25 Textile products and processing  FORMCHECKBOX  26 Transportation and lifting equipment (motor vehicles, aircraft and space, railroad, ships, hoists, conveyors)  FORMCHECKBOX  27 Other 21. Do not submit this form unless it bears the original signatures of all contributors and witnesses. 22. After obtaining all required signatures, send the original Disclosure of Invention, with all attachments, to the Office of Technology Transfer, GDYR 312, +2103. 4/02 XXXXXX\\T]V]j]l]n]x]z]__r`t````ӹөӁiӹӝZJ7J%jhcTCJOJQJU^JjhcTCJOJQJU^JhcT6CJOJQJ]^J.jh Fhk^>*CJOJQJU^Jh Fhk^>*CJOJQJ^Jh?CJOJQJ^JhcTCJOJQJ^Jh FhcT>*CJOJQJ^J3jh Fhk^>*CJOJQJU^JmHnHu(jh Fhk^>*CJOJQJU^J.j*h Fhk^>*CJOJQJU^J0YYpZ[[P\\\8^^(___r``abrccbddeffg2hhhx^h 80x^8`0xhx`h``aaa aaaaaabb"b$b&brctccccccdddbddddddddeeeeer_%jPhcTCJOJQJU^J%jhcTCJOJQJU^J%jdhcTCJOJQJU^J%jhcTCJOJQJU^J%jxhcTCJOJQJU^J%jhcTCJOJQJU^J%jhcTCJOJQJU^JjhcTCJOJQJU^JhcTCJOJQJ^J%efffffhffffggggg2h4hPhRhThhhhhhdifiiiiiiiiiFjHjdjr_%j!hcTCJOJQJU^J%j!hcTCJOJQJU^J%j hcTCJOJQJU^J%j( hcTCJOJQJU^J%jhcTCJOJQJU^J%j<hcTCJOJQJU^JjhcTCJOJQJU^J%jhcTCJOJQJU^JhcTCJOJQJ^J$hdiiFjj`kkVll^mm`n otozpp~qrrr$hx^h`a$ hx^h` 80x^8`0hx^hhx`hdjfjhjjjjjj`kbk~kkkkkkkkVlXltlvlxlllllll^m`m|mнЪЗЄub%jN$hcTCJOJQJU^JhcT6CJOJQJ]^J%j#hcTCJOJQJU^J%jb#hcTCJOJQJU^J%j"hcTCJOJQJU^J%jv"hcTCJOJQJU^JhcTCJOJQJ^JjhcTCJOJQJU^J%j"hcTCJOJQJU^J|m~mmmmmmm`nbn~nnn o o(o*o,orotovoooozp|ppнЪЗЈueYh^pCJOJQJ^Jjh^pCJOJQJU^J%j&hcTCJOJQJU^JhcT6CJOJQJ]^J%j&&hcTCJOJQJU^J%j%hcTCJOJQJU^J%j:%hcTCJOJQJU^JhcTCJOJQJ^JjhcTCJOJQJU^J%j$hcTCJOJQJU^Jpppq qq*rhrrrr;ͯͣ͗hcTCJOJQJ^Jh`CJOJQJ^JhcT6CJOJQJ]^JhcT5CJOJQJ\^JhcTCJOJQJ^Jjh^pCJOJQJU^J+j'h^ph^pCJOJQJU^J <00P&P/ =!"#$% Dp,1h/ =!"#$% vDText51tDText7vDText53vDText52tDText3tDText4tDText5vDText49tDeCheck1tDCheck2tDeCheck3vDText48tDText8tDText9vDText10vDText11vDText12vDText13vDText14vDText15vDText16vDText17vDText18vDText19vDText20vDText21vDText22vDText23vDText24vDText25vDText26vDText27vDText28vDText29vDText30vDText31vDText32vDText33vDText34vDText35vDText36tDeCheck4tDeCheck5vDText37vDText38vDText39vDText40vDeCheck40tDCheck7vDText41vDText42vDText43tDeCheck8tDeCheck9vDText44vDText45vDText54vDText46vDText47vDeCheck10vDeCheck11vDeCheck15vDeCheck16vDeCheck14vDeCheck17vDeCheck18vDeCheck19vDeCheck20vDeCheck21vDeCheck22vDeCheck23vDeCheck24vDeCheck25vDeCheck26vDeCheck27vDeCheck28vDeCheck29vDeCheck30vDeCheck31vDeCheck32vDeCheck33vDeCheck34vDeCheck35vDeCheck36vDeCheck37vDeCheck39^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA D Default Paragraph FontViV  Table Normal :V 44 la (k (No List HH # Balloon TextCJOJQJ^JaJPK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! 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Fk^KUW@ UXX X XXXXXXXXX X"X$XL@XXUnknownG* Times New Roman5Symbol3. * Arial5. *aTahomaA BCambria Math"hhfF77!24dFF2QHP?#*!xxDisclosure of Invention formShanthi Subashchandran Linda Smith Oh+'0   4@ ` l x  Disclosure of Invention formShanthi Subashchandran Normal.dotm Linda Smith4Microsoft Office Word@ա@4{v@!V@܍c՜.+,0 hp  ɫƵ7F Disclosure of Invention form Title  !"#$%&'()*+,-./0123456789:;<=>?@ABDEFGHIJKLMNOPQRSTUVXYZ[\]^_`abcdefghijklmnoqrstuvwyz{|}~Root Entry F@ћcData C'1TableW0WordDocumentlSummaryInformation(pDocumentSummaryInformation8xCompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q