NEW INVENTION NOTIFICATION

NEW INVENTION NOTIFICATION

University of Nebraska

General Instructions
General Instructions

The purpose of this New Invention Notification (NIN) form is to generate a written, dated record of your invention and to provide information from which the patent potential and commercial potential of your invention can be evaluated. The University needs this documentation to comply with most industrial contract requirements and the U.S. federal laws and regulations concerning grants and contracts. Please review the following information before completing the attached form.
- The NIN form is also available as a Microsoft Word or PDF document, and may be downloaded from the UNeMed website (www.unemed.com). Once completed, please return a copy signed by all inventors to UNeMed (electronic signatures and submission are acceptable).
- A New Invention Notification should be completed when something new and useful has been conceived or developed, or when unusual, unexpected or unobvious research results have been achieved and can be utilized. In accordance with the University of Nebraska Board of Regents Bylaw 3.10 and Policy 4.4.2, any such invention is to be promptly disclosed to the University.
- Identifying all individuals who contributed to the conception or development of the technology is very important. Please note that inventorship is not the same as authorship and will be determined according to U.S. patent law when a patent application is filed. When completing this form, it is best to list the potential pool of individuals who contributed to the conception and/or development of the invention.
- To fully and properly evaluate the invention, UNeMed must receive all data supporting the invention (tables, charts, graphs, presentations, manuscripts, etc).
- UNeMed will begin its internal review upon receipt of the signed, completed NIN. Questions or requests for meetings to discuss the NIN will be directed through the Primary Contact; however UNeMed encourages all potential inventors to participate as much as possible.
- Please do your best to complete as much of this form as possible. Incomplete NIN submissions may be delayed. If you have any questions, please contact UNeMed at 559-2468.
- If for any reason the information you need to add does not fit within the form, please feel free to add information as an attachment as necessary.
For advice on completing this NIN or for additional information, contact UNeMed. Upon completion of the NIN, a signed copy, along with all supporting documentation may be submitted to:

UNeMed

986099 Nebraska Medical Center

Omaha, NE 68198-6099

Phone: (402) 559-2468

Email: unemed@unmc.edu

Website: www.unemed.com

Title of Invention*
Provide a non-confidential title
Chronology of Invention

It is important to document when the invention was conceived.
Idea First Conceived:*

MonthDayYear
Approximate date
Location:*
Where invention was conceived and any comments
Have the essential elements of the Invention been communicated or disclosed to anyone outside of your laboratory—either orally or in writing—or do you intend to do so in the near future?*

YesNo
Please specify the circumstances of the disclosure, including dates, names and other relevant details:*
Funding Sources

List all funding sources for materials, equipment and/or salaries of all personnel involved in conception and development of the invention.
Funding Source*
Federal Funding Source*
State/local govt.*
Corporate/Industrial*
Foundation*
University/Department*
Other*
Additional Funding?

YesNo
Funding Source*
Federal Funding Source*
State/local govt.*
Corporate/Industrial*
Foundation*
University/Department*
Other*
Additional Funding?

YesNo
Funding Source*
Federal Funding Source*
State/local govt.*
Corporate/Industrial*
Foundation*
University/Department*
Other*
Additional Funding?

YesNo
Funding Source*
Federal Funding Source*
State/local govt.*
Corporate/Industrial*
Foundation*
University/Department*
Other*
Additional Funding?

YesNo
Funding Source*
Federal Funding Source*
State/local govt.*
Corporate/Industrial*
Foundation*
University/Department*
Other*
Additional Funding?

YesNo
Funding Source*
Federal Funding Source*
State/local govt.*
Corporate/Industrial*
Foundation*
University/Department*
Other*
Additional Funding?*

YesNo
Additional funding sources:*
Please list any remaining funding sources and any relevant info.
External Resources

List all agreements (e.g. MTA, CDA, consulting, contracts, or artificial intelligence tools) involved in conception and development of the invention.
Select resources*

Material TransferCDA/NDAConsultingContractArtificial Intelligence toolsOther or NONE
Please specify external resources:*
Include the all relevant information about the resource, such as the source, materials/resources used, the agreement/contract types and their dates.
The Invention
Detailed description of the invention:*
If necessary, additional descriptive information may be submitted via email as attachments to unemed@unmc.edu or here as a One Drive link, but be sure that UNeMed has permission to view and download the file(s). Additional information or files may include data charts, graphs, publications, abstracts, grant applications, presentations, photos, renderings, sketches, etc.
Please attach any files that would help us understand the invention:

Upload illustrations, figures, data, papers, presentations, abstracts, etc.
Cancelof
Inventor Identification

Include ALL potential inventors, including collaborators from other institutions outside the University of Nebraska. We will consult with the "Primary Contact" on whether and how best to contact any outside potential inventors.
ALL POTENTIAL INVENTORS AFFILIATED WITH THE UNIVERSITY OF NEBRASKA DURING THE CONCEPTION AND DEVELOPMENT OF THIS INVENTION MUST SIGN BELOW. BY SIGNING THIS NEW INVENTION NOTIFICATION FORM YOU HEREBY ASSIGN YOUR RIGHTS IN THIS INVENTION TO THE BOARD OF REGENTS OF THE UNIVERSITY OF NEBRASKA.

To the best of my knowledge all statements and information provided in this New Invention Notification (NIN) form are true and complete. I understand and agree that all rights, obligations, and financial interests pertaining to or derived from the invention are as determined under the University of Nebraska Board of Regents Bylaws and Policies, including, but not limited to Bylaw 3.10, Policy 4.4.1, Policy 4.4.2, and all applicable campus policies. I also understand and acknowledge that the University has the right to change the Policy from time to time, including the percentage of net royalties paid to me. Further, I acknowledge that the percentage of net royalties paid to inventors is derived only from consideration in the form of money or equity received under a license, option, or material transfer agreement for licensed rights. Per Policy 3.2.8, any conflict of interest will be handled according to specific campus policies which may require disclosure of a personal interest in the form of potential revenue through commercialization of an invention described in a publication or presentation. I agree to assist the University of Nebraska and UNeMed in the evaluation, possible protection and commercialization of the invention as described in this NIN.
Primary Contact

Person filling out this form
Name*

FirstLast
Citizenship*
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Do you have a University of Nebraska Campus address?*

YesNo
Campus Address*

Building

Room

City

Campus Zip
Phone*
Please enter a valid phone number.
Email*

Confirmation Emailexample@example.com
Affiliations*

UNMCUNLUNOUNKNon-University of Nebraska (please specify)
Veteran's Affairs (VA) appointment, with or without compensation?*

YesNo
Department:*
Additional Inventors

Provide names and email addresses for all other potential collaborators who may have contributed to this invention. The order in which they are listed is not important, but it is important for all University of Nebraska inventors to sign their own copy of this NIN form. All listed co-inventors will receive their own copy via email. The process cannot continue until all University of Nebraska inventors have signed their copies. Contact UNeMed with any questions about this important step: 402-559-2468, unemed@unmc.edu.
Are there additional inventors?*

YesNo
Inventor 2*

FirstLast
Inventor 2 Email*

Confirmation Emailexample@example.com
Are there additional inventors?*

YesNo
Inventor 3*

FirstLast
Inventor 3 Email*

Confirmation Emailexample@example.com
Are there additional inventors?*

YesNo
Inventor 4*

FirstLast
Inventor 4 Email*

Confirmation Emailexample@example.com
Are there additional inventors?*

YesNo
Inventor 5*

FirstLast
Inventor 5 Email*

Confirmation Emailexample@example.com
Are there additional inventors?*

YesNo
Inventor 6*

FirstLast
Inventor 6 Email*

Confirmation Emailexample@example.com
Are there additional inventors?*

YesNo
Inventor 7*

FirstLast
Inventor 7 Email*

Confirmation Emailexample@example.com
Are there additional inventors?*

YesNo
Inventor 8*

FirstLast
Inventor 8 Email*

Confirmation Emailexample@example.com
Are there additional inventors?*

YesNo
Inventor 9*

FirstLast
Inventor 9 Email*

Confirmation Emailexample@example.com
Are there additional inventors?*

YesNo
Inventor 10*

FirstLast
Inventor 10 Email*

Confirmation Emailexample@example.com
Are there additional inventors?*

YesNo
Inventor 11*

FirstLast
Inventor 11 Email*

Confirmation Emailexample@example.com
Are there additional inventors?*

YesNo
Inventor 12*

FirstLast
Inventor 12 Email*

Confirmation Emailexample@example.com
Are there additional inventors?*

YesNo
Inventor 13*

FirstLast
Inventor 13 Email*

Confirmation Emailexample@example.com
Are there additional inventors?*

YesNo
Inventor 14*

FirstLast
Inventor 14 Email*

Confirmation Emailexample@example.com
Are there additional inventors?*

YesNo
Inventor 15*

FirstLast
Inventor 15 Email*

Confirmation Emailexample@example.com
Are there additional inventors?*

YesNo
Inventor 16*

FirstLast
Inventor 16 Email*

Confirmation Emailexample@example.com
Are there additional inventors?*

YesNo
Inventor 17*

FirstLast
Inventor 17 Email*

Confirmation Emailexample@example.com
Are there additional inventors?*

YesNo
Inventor 18*

FirstLast
Inventor 18 Email*

Confirmation Emailexample@example.com
Are there additional inventors?*

YesNo
Inventor 19*

FirstLast
Inventor 19 Email*

Confirmation Emailexample@example.com
Are there additional inventors?*

YesNo
Inventor 20*

FirstLast
Inventor 20 Email*

Confirmation Emailexample@example.com
Are there additional inventors?*

YesNo
Inventor 21*

FirstLast
Inventor 21 Email*

Confirmation Emailexample@example.com
If there are more than 21 inventors, please send an email with this invention title as the subject to unemed.com. List all remaining inventor names and email addresses, and any other important information.
Signature*

Clear
Please verify that you are human*
Should be Empty:

NEW INVENTION NOTIFICATION

Chronology of Invention

Funding Sources

External Resources

The Invention

Inventor Identification

Primary Contact

Additional Inventors