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?
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?
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

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Term in years of the Agreement
10 years is the maximum duration allowed for a testing Agreement. If any additional time is needed, we can review and extend the Agreement at the expiration date.
Propagation
Is propagation allowed?
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?
What is the Invention Number?
Is the Plant Material itself to be kept confidential (i.e. – not published or publicly disclosed)
Are you sharing Confidential Information in addition to the Plant Material?
Please give a brief, non-confidential summary of the information to be shared
Will the Other Party share confidential information with UMN?
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?
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?
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
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?
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

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Are you the creator/inventor of the Plant Material?
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.

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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?)
Please Explain
Please attach a copy of the original incoming PMTA if the material originated outside of UMN

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

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

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

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Should there be any restrictions on the Recipient’s use of the Plant Material and/or confidential information
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
Please describe as completely as possible
Permitted Uses
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