INNOVATION / TECHNOLOGY LICENSING APPLICATION
Section I: Company Information (required)
Company Name:
*
Company Formed?
*
Yes
No
Legal Entity Type:
*
Date of Company Formation:
-
Month
-
Day
Year
If Company is not formed, what is planned date of formation?
-
Month
-
Day
Year
Company Headquarters:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Company Email:
*
example@example.com
Company Management Team:(Names and titles):
*
Primary Licensing Contact (name):
*
First Name
Last Name
Job Title
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Additional Information Required:
If new start-up or pre-incorporation, please attach resumes/CVs of the management team.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
If existing company, please provide balance sheet and income statement for past three (3) years.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Section II: Affirmation of Interest (required)
List the University of South Carolina innovations/technologies in which your company is interested (Tech ID / Title / Description):
*
How did you learn about these technologies? (e.g. Inventor, USC website, Conference, Publication):
*
What type of relationship is your company interested in? (Check all that apply)
*
License (Exclusive)
License (Non-Exclusive)
Option
Sponsored Non-Commercial Research
Other
Intended Use of the Innovation/Technology:
Desired Field(s) of Use:
*
Desired Territory Use:
*
Planned Products or Services incorporating the technology: (Please describe all)
*
How will the innovation/technology be used in any planned products and or services listed above:
*
If an “Option” is selected, what are the planned activities for the option period?
*
USC Affiliation Information
Are any University of South Carolina employees listed as Founders, Owners or Officers?
*
Yes
No
If "yes", please list names and job titles of individuals:
*
Are any University of South Carolina employees who have an equity interest in Company?
*
Yes
No
If "yes", please list names and job titles of individuals:
*
For each University of South Carolina employee named above, has a Conflict of Interest Disclosure been submitted?
*
Yes
No
If “yes,” please specify date of submission:
-
Month
-
Day
Year
If “no,” what is the anticipated date of submission:
-
Month
-
Day
Year
Section III – Market Segment Information (Required for Commercial Licensee Applicants)
Target Market Segments and Description:
Estimated Market Size for US:
Estimated Market Size globally:
Projected Market Growth Rate:
Projected Date of Market Entry and first commercial sale of licensed products/services:
-
Month
-
Day
Year
Timeline of Estimated Sales Growth: (Attach additional documentation if necessary)
Summary of currently existing competition:
*
Description of competitive advantage(s) of Company’s created by Technology/Innovation into licensed products and/or services:
*
Identify potential barriers to entry for licensed products and/or services:
*
Section IV: Product/Service Development Plan (Required for Commercial Licensee Applicants)
Briefly describe the following:
Planned steps to develop product and/or service to maturity and estimated timelines:
Estimated investment / resources required for each of the aforementioned steps proposed:
Sources of investment for the developmental plan (Internal & External):
Any current or anticipated strategic alliances or partnerships that will help in development plan:
Note: Any other considerations for evaluation. Please attached additional documentation, if necessary.
Signature
*
Job Title:
*
Date
*
-
Month
-
Day
Year
USC INNOVATION LICENSE APPLICATION: Rev. 2.23.26
Submit
Submit
Should be Empty: