PMTA - Tech Comm Agreement Request

Plant Material Transfer Agreement (PMTA) Request Form
Dear Requestor,

Please proceed to answer the questions below. This request form is set up to alter the questions asked based on your input, so you are not prompted with questions that are not relevant to the agreement you are requesting.

This request form may ask you to upload files relevant to the agreement you wish to request. If any of the files listed below are relevant to this agreement, you should ensure that you know where these files are located and are able to upload them to this form if they are requested.

Possible Files to upload:
- Original Incoming PMTA for 3rd Party Material
- Written Permission from owner/creator of 3rd Party Material (Saved Email)
- Plant Material Research/Funding Agreements
If you have trouble completing this form, please contact otcagree@umn.edu

Thank you,

Contracts Staff
General Questions
Internal Only; office email
example@example.com
Who is filling out this form?*
UMN Principal Investigator Name*

First NameLast Name
UMN Principal Investigator Email*
example@umn.edu
Name of Person filling out this form*

First NameLast Name
Email of Person filling out this form*
example@umn.edu
Technology Commercialization Staff Name*

First NameLast Name
Technology Commercialization Staff Email*
example@umn.edu
Helper Date Field; Not Shown; INTERNAL ONLY

MonthDayYear
Date
Date Required By

MonthDayYear
Primary Technology Commercialization Staff Contact

First NameLast Name
Is the other party outside of the United States?*

YesNo
Name of the Other Party to the Agreement (Organization Name)*
Other Party's Address*
Other Party Contact/Scientist Name*

First NameLast Name
Other Party Scientist/Contact Email*
example@example.com
Signatory

Authorized signatory at the other party's institution
Signatory Name (if not known, leave blank)

First NameLast Name
Signatory Email (if not known, leave blank)
example@example.com
PMTA Questions
Reporting

All PMTAs have a reporting requirement
University of Minnesota's Recipient of Reports Name*

First NameLast Name
University of Minnesota's Recipient of Reports Email*
example@example.com
Are there any additional report requirements?*

YesNo
Additional Report Requirements*
Plant Material

Please submit one PMTA per species
Scientific name (please only submit ONE species per request, multiple selections are OK)*
Description of Plant Material being sent (variety/selection name + type of material) For example ('UMN1801' budwood or 'M10-87345' seeds) *
Please specify type of material (for example: budwood, root stock, tubers, etc.)
File with Plant Material Description

Cancelof
Term in years of the Agreement *
Propagation
Is propagation allowed?*

YesNo
Allowable propagation method(s)*
What type of Plant Material may be propagated?*
What is the maximum amount of Plant Material that may be propagated?*
Territory where the Other Party may test the Plant Materials *
Example: country, state, or region
Additional Questions
Has the Plant Material has been disclosed as part of an invention to the Technology Commercialization Office?*

YesNo
What is the Invention Number?
Is the Plant Material itself to be kept confidential (i.e. – not published or publicly disclosed)*

YesNo
Are you sharing Confidential Information in addition to the Plant Material?*

YesNo
Please give a brief, non-confidential summary of the information to be shared *
Will the Other Party share confidential information with UMN?*

YesNo
Please give a brief, non-confidential summary of the information being shared
Do you and your research team members understand what information will be provided by the Other Party to UMN that will need to be kept confidential?*

YesNo
Do you have processes in place to ensure that neither you nor anyone in your lab or under your direction will disclose confidential information that the Other Party provides to UMN?*

YesNo
What processes do you have in place to ensure no confidential information is disclosed?
Please check the radio button to acknowledge that you have read the text below*

Please contact the University’s Office of the General Counsel, Arnie Frishman frish003@umn.edu to discuss your obligations under this MTA.
3rd Party Material Questions

If the Plant Material incorporates or was made with plant material provided by a third party, (for example, does the Plant Material have in its pedigree plant material you received from a third party?) then the incoming terms may prevent UMN from further distributing the Plant Material. Or the incoming terms may impose specific restrictions on how and to whom UMN may further distribute the Plant Materials or modifications of the Plant Materials. These incoming terms must be reviewed to ensure that the UMN follows the incoming terms.
Was the Material created at the University of Minnesota?*

YesNo
What is the name of the 3rd party organization who provided the Plant Material to you?*
Please attach a copy of the original agreement or correspondence if the material originated outside of UMN

Cancelof
Are you the creator/inventor of the Plant Material?*

YesNo
Who created the Plant Material?*

First NameLast Name
Who created the plant material? (Please list all inventors. For those who have retired/left the University, please provide written permission via email, or attach correspondence below)
Provide written permission from the creator/owner of the material allowing UMN to forward the Plant Material to the Other Party to the agreement.

Cancelof
Does the Plant Material incorporate or was it made with plant material provided by a third party (i.e. does the Plant Material have in its pedigree plant material you received from a third party?)*

YesNo
Please Explain*
Please attach a copy of the original incoming PMTA if the material originated outside of UMN

Cancelof
Does Anyone else have rights In the Plant Material that could preclude the University from entering into this Agreement (for example incoming MTA, License or Option Agreement, Sponsored Research Agreement, etc)*

YesNo
Please detail the restrictions *
Provide a copy of the agreement(s)

Cancelof
Please check all applicable funding sources for the development of the Plant Material, and indicate source*

Federal funding (for example United States Department of Agriculture (USDA) , National Science Foundation (NSF), etc.).Non-federal funding (for example Minnesota Department of Agriculture (MDA), United Soy Bean (USB) , Minnesota Soybean Research and Promotion Council (MSRPC), etc.).Company sponsored research (for example PepsiCo., Minnesota Innovation Partnerships (MN-IP) , etc.)Internal funding (for example, startup funds, departmental funds, royalty funds, etc.)Other
List the funding sources for the development of the Plant Material that you checked above
Please attach the research/funding agreements for the boxes you have checked above

Cancelof
Should there be any restrictions on the Recipient’s use of the Plant Material and/or confidential information*

YesNo
Please detail the restrictions (for example, specific research project)*
Does the Plant Material and/or Confidential Information require any sort of export or import permit in connection with shipment to a foreign country*

YesNoI Don't Know
Please describe as completely as possible*
Permitted Uses*

Use for non-commercial, research, academic and/or education purposes onlyEvaluate for Commercial PurposesOther - please describe below
Additional Notes
Additional Files

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Should be Empty:

Plant Material Transfer Agreement (PMTA) Request Form

General Questions

Signatory

PMTA Questions

Reporting

Plant Material

Propagation

Additional Questions

3rd Party Material Questions