DS-IDS-20250209-3

PART I. IDENTIFYING INFORMATION

PERSON SUBMITTING THE FORM
Full name
Are you the inventor?	Yes No
Submission Date
Mailing Address

OWNER/ASSIGNEE APPLICANT
Assignee is applicant?	Yes No
Entity Size

PART II. APPLICATION FILING INFORMATION

Expedited prosecution?	Yes No
International filing?	Yes No

Domestic Priority Applications
Application Number	Filing Date	Title

Foreign Priority Applications
Country	Application Number	Filing Date	Reason

PART III. INVENTION INFORMATION

Full Legal Name	Employer	Mailing Address	Telephone	Email	Residency	Signature

Therapeutic Product

Medical Device

Diagnostic Method

Software Solution

Manufacturing Process

Research Reagent

Biological Material

Chemical Compound

Descriptive Title
Technical Problem Solved
Novel Features

PART IV. OTHER INFORMATION

Conception Date
First Reduction to Practice
Public Disclosure Date

PART V. REFERENCES

Document Number	Issue Date	Applicant	Page/Line	Disclosed?

PART VI. OTHER INVENTIONS

Software Language
Target Platforms
Hardware Requirements
Distribution Model	Open Source Commercial License

DS-IDS-20250209-2

PART II. APPLICATION FILING INFORMATION

Domestic Priority Applications

Application Number	Filing Date	Title

Foreign Priority Applications

Country	Application Number	Filing Date	Reason for Filing

PART III. INVENTION INFORMATION

Descriptive Title
Purpose
Prior Knowledge
Technical Problem Solved
New Features
Advantages Over Prior Art
Operating Principle

Therapeutic Product

Medical Device

Diagnostic Method

Software Solution

Manufacturing Process

Research Tool

Biological Material

Chemical Compound

Attach system diagrams, component illustrations, and process flowcharts

PART VI. OTHER INVENTIONS

Programming Language
Target Platforms
Hardware Requirements
User Interface Type

Distribution Model

Open Source Commercial License SaaS (Cloud)

DS-IDS-20250209

PART I. IDENTIFYING INFORMATION

PERSON SUBMITTING THE FORM
Full name
Are you the inventor?	Yes No

OWNER/ASSIGNEE APPLICANT
Patent rights ownership?	Yes No

Other parties of interest
Possible licensees

PART II. APPLICATION FILING INFORMATION

Expedited prosecution?

Yes No

Attach priority application details

PART III. INVENTION INFORMATION

Full Legal Name	Employer	Mailing Address	Telephone	Email	Residency	Signature

Service Product - therapeutic

Product - device

Product - method

Research - reagent

Descriptive title
Purpose

Attach system diagrams and component illustrations

PART IV. OTHER INFORMATION

Conception Date
Reduction to Practice Date

Public disclosure made?

Yes No

PART V. REFERENCES FOR DISCLOSURE

Ref #	Document Number	Issue Date	Applicant	Page/Line	Disclosed?

PART VI. OTHER INVENTIONS

Programming Language
Operating System

DS-IDS-20250208-2

PART I. IDENTIFYING INFORMATION

PERSON SUBMITTING THE FORM
Full name
Are you the inventor?	Yes No

OWNER/ASSIGNEE APPLICANT
Do inventors own patent rights?	Yes No

Other parties of interest
Licensees

PART II. APPLICATION FILING INFORMATION

Expedited prosecution?

Yes No

PART III. INVENTION INFORMATION

Full Legal Name	Employer	Mailing Address	Telephone	Email	Residency	Signature

INVENTION CATEGORY
Service Product - therapeutic	Product - device	Product - method	Research - reagent

FDA filing expected?

Yes No

PART IV. OTHER INFORMATION

Conception Date
Reduction to Practice Date

USE AND DISCLOSURE
Disclosed to anyone?	Yes No

PART V. REFERENCES FOR DISCLOSURE

Ref #	Document Number	Issue Date	Applicant	Page/Line	Disclosed?

PART VI. OTHER INVENTIONS

SOFTWARE INVENTIONS
Programming Language

DISTRIBUTION MODEL
Open Source	Beta Test	Academic Use	Software Reseller

DS-IDS-20250208

PART I. IDENTIFYING INFORMATION

PERSON SUBMITTING THE FORM
Full name
Are you the inventor?	Yes No
Submission date
Mailing address
Business telephone
E-mail address
Cell phone

OWNER/ASSIGNEE APPLICANT

Do the inventor(s) own the patent rights?

Yes No

Is the assignee also the applicant?

Yes No

Applicant mailing address

Applicant physical address

Applicant telephone

Applicant email address

Applicant entity size

Signatory Title

Signatory Name

Other parties of interest

University

DS-IDS-20250208-3/3

PART I. IDENTIFYING INFORMATION

PERSON SUBMITTING THE FORM
Full name
Are you the inventor?	Yes No
Submission date
Mailing address
Business telephone
E-mail address
Cell phone

OWNER/ASSIGNEE APPLICANT
Do the inventor(s) own the patent rights?	Yes No
Is the assignee also the applicant?	Yes No
Applicant mailing address
Applicant physical address
Applicant telephone
Applicant email address
Applicant entity size
Signatory Title
Signatory Name
Other parties of interest	University Contract Government Agreement Joint Development Other
Possible licensees

PART II. APPLICATION FILING INFORMATION

Expedited prosecution?

Yes No

International filing?

Yes No

Foreign countries for filing

Requesting non-publication?

Yes No

Requesting early publication?

Yes No

Domestic priority applications

Application #	Filing Date	Title

Foreign priority applications

Application #	Country	Filing Date

Common inventors with priority apps?

Yes No

PART III. INVENTION INFORMATION

Inventors

Full Name	Employer	Mailing Address	Email	Residency

INVENTION CATEGORY
Service Product - therapeutic Product - device Product - method Research - reagent Diagnostic - test Bio Software

INVENTION DETAILS
Descriptive title
Purpose
Prior knowledge
Prior knowledge limitations
Reasons for shortcomings
Detailed description
Technical problem solved
New features
Advantages
New capabilities
Operating principle
Principle differences
Physical structure

PART IV. OTHER INFORMATION

SIGNIFICANT DATES
Conception date
Documentation date
Reduced to practice date

USE AND DISCLOSURE
Disclosed to anyone?	Yes No
Commercialization attempts?	Yes No
Published in media?	Yes No
Used in commerce?	Yes No
Manufacturing/sales attempts?	Yes No
Witnesses	Yes No
State-of-art searches?	Yes No

PART V. REFERENCES FOR DISCLOSURE

Document #	Issue Date	Application	Relevant Pages	Discussed

PART VI. OTHER INVENTIONS

SOFTWARE RELATED INVENTIONS
Development language
Operating system requirements
Required application software
Hardware requirements
Graphical interface?	Yes No
Customization requirements
Maintenance needs
Commercial uses
End users
Distribution model
Open-source components

BIO INVENTIONS
Mechanism of action
Key components/reagents
Methods/protocols
Experimental data
Advantages/improvements
External materials used?	Yes No
Readiness level
Future steps

DS-IDS-20250208-5/5

PART IV. OTHER INFORMATION

SIGNIFICANT DATES
Conception date
Documentation date
Reduced to practice date

USE AND DISCLOSURE
Disclosed to anyone?	Yes No
Commercialization attempts?	Yes No
Published in media?	Yes No
Used in commerce?	Yes No
Manufacturing/sales attempts?	Yes No
Witnesses	Yes No
State-of-art searches?	Yes No

PART V. REFERENCES FOR DISCLOSURE

Document #	Issue Date	Application	Relevant Pages	Discussed

PART VI. OTHER INVENTIONS

SOFTWARE RELATED INVENTIONS
Development language
Operating system requirements
Required application software
Hardware requirements
Graphical interface?	Yes No
Customization requirements
Maintenance needs
Commercial uses
End users
Distribution model
Open-source components

BIO INVENTIONS
Mechanism of action
Key components/reagents
Methods/protocols
Experimental data
Advantages/improvements
External materials used?	Yes No
Readiness level
Future steps

DS-IDS-20250208-4/4

PART I. IDENTIFYING INFORMATION

PERSON SUBMITTING THE FORM
Full name
Are you the inventor?	Yes No
Submission date
Mailing address
Business telephone
E-mail address
Cell phone

OWNER/ASSIGNEE APPLICANT
Do the inventor(s) own the patent rights?	Yes No
Is the assignee also the applicant?	Yes No
Applicant mailing address
Applicant physical address
Applicant telephone
Applicant email address
Applicant entity size
Signatory Title
Signatory Name
Other parties of interest	University Contract Government Agreement Joint Development Other
Possible licensees

PART II. APPLICATION FILING INFORMATION

Expedited prosecution?

Yes No

International filing?

Yes No

Foreign countries for filing

Requesting non-publication?

Yes No

Requesting early publication?

Yes No

Domestic priority applications

Application #	Filing Date	Title

Foreign priority applications

Application #	Country	Filing Date

Common inventors with priority apps?

Yes No

PART III. INVENTION INFORMATION

Inventors

Full Name	Employer	Mailing Address	Email	Residency

INVENTION CATEGORY
Service Product - therapeutic Product - device Product - method Research - reagent Diagnostic - test Bio Software

INVENTION DETAILS
Descriptive title
Purpose
Prior knowledge
Prior knowledge limitations
Reasons for shortcomings
Detailed description
Technical problem solved
New features
Advantages
New capabilities
Operating principle
Principle differences
Attach diagrams	[File upload placeholder]

PART IV. OTHER INFORMATION

SIGNIFICANT DATES
Conception date
Reduced to practice date
USE AND DISCLOSURE
Disclosed to anyone?	Yes No

PART I. IDENTIFYING INFORMATION

PERSON SUBMITTING THE FORM
Full name
Are you the inventor?	Yes No
Submission date
Mailing address
Business telephone
E-mail address
Cell phone

OWNER/ASSIGNEE APPLICANT
Do the inventor(s) own the patent rights?	Yes No
Is the assignee also the applicant?	Yes No
Applicant mailing address
Applicant physical address
Applicant telephone
Applicant email
Applicant entity size

PART II. APPLICATION FILING INFORMATION

Is this application seeking expedited prosecution?

Yes No

Is this application being filed internationally?

Yes No

Foreign countries for filing

Requesting non-publication?

Yes No

Foreign References

Document #	Issue Date	Application	Relevant Pages

Domestic References

Document #	Issue Date	Application	Relevant Pages

PART III. INVENTION INFORMATION

Inventors

Full Legal Name	Employer	Mailing Address	Email

INVENTION CATEGORY
Service Product - therapeutic Product - device Product - method

INVENTION DETAILS

Descriptive title
Purpose
Prior knowledge

STLG-INVENTION DISCLOSURE FORM

PART I. IDENTIFYING INFORMATION

PERSON SUBMITTING THE FORM
Full name
Are you the inventor	Yes No
Submission date
Mailing address
Business telephone
E-mail address
Cell phone
OWNER/ASSIGNEE APPLICANT
Patent rights ownership	Yes No
Assignee is applicant?	Yes No
Applicant mailing address
Applicant physical address
Applicant telephone
Applicant email
Entity size
Other parties of interest	University Contract Government Other

PART II. APPLICATION FILING INFORMATION

Expedited prosecution?	Yes No
International filing?	Yes No
Non-publication request?	Yes No
Domestic priority apps
Foreign priority apps

PART III. INVENTION INFORMATION

Full Legal Name	Employer	Mailing Address	Telephone	Email	Residency	Signature

PART IV. OTHER INFORMATION

Conception Date
Reduction to Practice Date
Public Disclosure	Yes No

PART V. REFERENCES

Document #	Issue Date	Application	Relevant Pages	Discussed?

PART VI. SOFTWARE & BIO INVENTIONS

Programming Language Operating System

Distribution Model Contains Open-Source Code?

Yes No

BIO INVENTIONS

Core Concept
Key Components
Material Source

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STLG-INVENTION DISCLOSURE FORM

PART V. REFERENCES FOR DISCLOSURE

Document #	Issue/Publication Date	Application/Patentee	Relevant Pages/Lines	Discussed?

PART VI. OTHER INVENTIONS

SOFTWARE RELATED INVENTIONS

Programming Language Operating System Required Applications

Hardware Requirements Distribution Model Contains Open-Source Code?

Yes No

BIO INVENTIONS

Core Concept Key Components

Experimental Data Unique Protocols

Material Source

Transfer Agreements?

Yes No

STLG-INVENTION DISCLOSURE FORM

PART V. REFERENCES FOR DISCLOSURE

Document #	Issue/Publication Date	Application/Patentee	Relevant Pages/Lines	Discussed?

PART VI. OTHER INVENTIONS

SOFTWARE RELATED INVENTIONS

Programming Language Operating System Required Applications

Hardware Requirements Distribution Model Contains Open-Source Code?

Yes No

BIO INVENTIONS

Core Concept Key Components

Experimental Data Unique Protocols

Material Source

Transfer Agreements?

Yes No

STLG-INVENTION DISCLOSURE FORM

PART I. IDENTIFYING INFORMATION

PERSON SUBMITTING THE FORM
Full name
Are you the inventor	Yes No
Submission date
Mailing address
Business telephone
E-mail address
Cell phone
OWNER/ASSIGNEE APPLICANT
Do inventors own patent rights?	Yes No
Assignee is applicant?	Yes No
Applicant mailing address
Applicant physical address
Applicant telephone
Applicant email
Entity size
Signatory information
Other parties of interest	University Contract Government Other
Licensees

PART II. APPLICATION FILING INFORMATION

Expedited prosecution?	Yes No
International filing?	Yes No
Foreign countries for filing
Non-publication request?	Yes No
Early publication?	Yes No
Domestic priority applications
Foreign priority applications
Common inventors with priority apps?

PART III. INVENTION INFORMATION

Full Legal Name	Employer	Mailing Address	Telephone	Email	Residency	Signature

INVENTION CATEGORY

FDA FILING

Expect FDA filing?

Yes No

INVENTION DETAILS

Descriptive title
Purpose
Prior knowledge
Prior knowledge limitations
Technical problem solved
New features
Advantages
Operating principle

PART IV. OTHER INFORMATION

Conception date
Reduction to practice date
Public disclosures	Yes No
Commercialization attempts	Yes No
Published descriptions	Yes No

PART V. REFERENCES

Document #	Issue Date	Application	Relevant Pages	Discussed?

ATTACHMENTS

Attach system diagram

Attach component diagram

STLG-INVENTION DISCLOSURE FORM

PART I. IDENTIFYING INFORMATION

PERSON SUBMITTING THE FORM
Full name
Are you the inventor	Yes No
Submission date
Mailing address
Business telephone
E-mail address
Cell phone
OWNER/ASSIGNEE APPLICANT
Own patent rights?	Yes No
Assignee is applicant?	Yes No

PART II. APPLICATION FILING INFORMATION

Expedited prosecution?

International filing?

PART III. INVENTION INFORMATION

Full Legal Name (Last, First, Middle)	Employer	Mailing Address	Telephone	E-mail	Residency	Signature

PART IV. OTHER INFORMATION

Conception Date
Reduction to Practice Date

PART V. REFERENCES

Document #	Issue Date	Application	Relevant Pages	Discussed?

PART VI. SOFTWARE & BIO INVENTIONS

Programming Language

Operating System

Soody Tronson2025-02-09T11:42:36-08:00

Form Test

Form Test

PART I. IDENTIFYING INFORMATION

PART II. APPLICATION FILING INFORMATION

PART III. INVENTION INFORMATION

PART IV. OTHER INFORMATION

PART V. REFERENCES

PART VI. OTHER INVENTIONS

PART II. APPLICATION FILING INFORMATION

Domestic Priority Applications

Foreign Priority Applications

PART III. INVENTION INFORMATION

PART VI. OTHER INVENTIONS

PART I. IDENTIFYING INFORMATION

PART II. APPLICATION FILING INFORMATION

PART III. INVENTION INFORMATION

PART IV. OTHER INFORMATION

PART V. REFERENCES FOR DISCLOSURE

PART VI. OTHER INVENTIONS

PART I. IDENTIFYING INFORMATION

PART II. APPLICATION FILING INFORMATION

PART III. INVENTION INFORMATION

PART IV. OTHER INFORMATION

PART V. REFERENCES FOR DISCLOSURE

PART VI. OTHER INVENTIONS

INVENTION DETAILS

STLG-INVENTION DISCLOSURE FORM

STLG-INVENTION DISCLOSURE FORM

STLG-INVENTION DISCLOSURE FORM

STLG-INVENTION DISCLOSURE FORM

STLG-INVENTION DISCLOSURE FORM

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