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Invention Disclosure Form

 
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Foip Statement

The personal information requested on this form is collected under the authority of Section 33 (c) of the Alberta Freedom of Information and Protection of Privacy Act (“Act”) and will be protected under Part 2 of the Act. The information is collected for the purpose of recognizing an Invention Disclosure, and to further contact the applicant.  
 
If you have any inquiries in regards to the collection of your personal information, please direct those inquiries to:  FOIP Coordinator, University of Lethbridge, 4401 University Dr. West, Lethbridge, Alberta T1K 3M4, telephone: 403-332-4620, email: foip@uleth.ca.
If you have any inquiries in regards the Invention Disclosure Form or any other University-Industry Liaison (UILO) programs & forms, please direct those inquiries to: Greg Vilk, UILO Manager, University of Lethbridge, 4401 University Dr. West, Lethbridge, Alberta T1K 3M4, telephone: 403-317-2860, email: greg.vilk@uleth.ca

Purpose

This secure and confidential disclosure form is your first step in the innovation process. Any early-stage discoveries which are common in leading-edge world-renowned Institutions such as the University of Lethbridge are initially disclosed to the UILO office via the Inventions Disclosure Form (IDF) for review on:

  • The stage of development
  • Commercial potential
  • Market potential
  • IP protection strategy
  • Capital requirements for successful commercialization
  • Other pertinent translatable strategies

to mobilize your creative knowledge for society’s benefit.  With deep and applied expertise in commercialization, the UILO professionals are there to work together with you to build and sustain your commercialization endeavors either through licensing, partnering or new company formation.
 
The IDF helps you communicate your early-stage innovative findings so our team can quickly evaluate its potential.
 
Start today so we can begin the journey together!

1. Invention
2. Principal Inventor

Note to Principal Inventor:

  • If more Co-Inventors, please add co-inventor attachment below.
  • If tenured from another institution, but U Lethbridge adjunct or affiliated, please indicate.

It is the responsibility of all inventors to keep the University-Industry Liasion Office informed of address changes

Note: Person to whom inquiries for additional information should be made.
3. Co-Inventor(s)
Co-Inventor 1
Note: Person to whom inquiries for additional information should be made.
Co-Inventor 2
Note: Person to whom inquiries for additional information should be made.
Co-Inventor 3
Note: Person to whom inquiries for additional information should be made.
Co-Inventor 4
Note: Person to whom inquiries for additional information should be made.
Co-Inventor Attachment
Please attach any other co-inventors here. Please keep in same format as above.
More information
  • Files must be less than 2 MB.
  • Allowed file types: gif jpg jpeg png pdf doc docx xls xlsx zip.
Principal Inventor Agreement
4. Invention Details

For the Invention Disclosure Form (IDF) , The University of Lethbridge will reserve the right to share information in this IDF on a confidential basis, as part of an inter-institutional agreement. The University of Lethbridge is committed to the protection of all personal information in accordance with the principles set out in the provisions of the University's Guidelines/Policies. PIPEDA and the Freedom of Information and Protection of Privacy Act of Alberta in regards to Access to Information and Protection of Privacy. The University will comply with PIPEDA, The Freedom of Information and Protection of Privacy Act of Alberta and with respect to all personal information collected, used or disclosed by it in the course of commercial activities.

Invention Information

Provide details about the invention. Please attach sketches, drawings, photographs, screen prints and other materials to help illustrate the description.

More information
  • Files must be less than 2 MB.
  • Allowed file types: gif jpg jpeg png pdf doc docx xls xlsx zip.
More information
  • Files must be less than 2 MB.
  • Allowed file types: gif jpg jpeg png pdf doc docx xls xlsx zip.
More information
  • Files must be less than 2 MB.
  • Allowed file types: gif jpg jpeg png psd pdf doc docx xls xlsx zip.
More information
  • Files must be less than 2 MB.
  • Allowed file types: gif jpg jpeg png pdf doc docx xls xlsx zip.
Please identify the commercial space in which this invention resides. If possible, provide a list of commercial entities that populate this commercial space and would possess similar technologies and approaches.
Please identify, from your prospective, the novel and distinguishing features of the invention. Consider what problem the invention solves; how this solution differs from existing technologies (if any) and how these differences are advantageous over these existing technologies.
Describe alternate technologies/products which you are aware accomplish the same purpose as this invention, along with the companies that market, manufacture or make use of them. If not known, please state: "Not aware of any alternate technologies/companies".
List patent applications that are known (Title and application number)
9. Invention History
A - Initial Idea
B - Description of complete invention, oral or written
C - First successful demonstration (reduction to practice)
D - First publication (article, thesis, oral presentation, abstracts, poster)
E - Disclosures to industry
F - Other disclosures
G - Related to other inventions? (List IDF #(s), if any, previously reported to UILO)
H - Are your lab books and other records in order and available?

The records produced based on this document contains information that would reveal trade secrets of the Contributor(s) or commercial, financial, scientific or technical information of the Contributor(s) that is supplied in confidence, the disclosure of which could be expect to either:

  • Harm significantly the competitive position or interfere significantly with the negotiating positon of the Contributor(s) or their Agent(s); or
  • Result in similar information no longer being supplied to the Univeristy when it is in the public interest that similar information continue to be supplied; or
  • Result in undue financial loss to the Contributor(s).

Accordingly, except as required by law or as otherwise permitted pursuant to the terms of this Document, neither the University nor the Contributor(s) will disclose the contents of this Document or the foregoing records other than:

  • For the purpose of implementation or enforcement of the same; or
  • A general statement on the parties to the Document and the Title of the Technology, either party being entitled to publish that information.

Once completed and submitted, please forward any additional documentation to:

Univeristy-Industry Liasion Office
Office of Research and Innovation Services
The University of Lethbridge
Room B634, University Hall
Lethbridge, AB, Canada T1K 3M4

* Within 30 days of receipt of this Report of Invention, a meeting with the University-Industry Liasion Manager will determine whether additional information (detailed disclosure) is required.