Confidential Innovation Disclosure Form
General Information - Page 1/4
Enter a brief title that describes your innovation
*
Share any abstracts that you may have already developed that describes the innovation
*
0/2000
Primary contributor's full name
*
First Name
Middle Name
Last Name
Primary contributor's email address
*
Primary contributor's Department at AUC
*
Please Select
Architecture
Biology
Chemistry
Computer
Construction
Electronics & Communications
Mechanical
Math
Petroleum & Energy
Physics
Other
Primary contributor's Citizenship
*
Primary contributor's home address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Primary contributor's primary mobile phone number
*
Please add contributors to the form as necessary (dynamic table) (Scroll right to ensure you fill in the mandatory mobile number field)
2nd AUC Department that was involved (if any)
Please Select
Architecture
Biology
Chemistry
Computer
Construction
Electronics & Communications
Mechanical
Math
Petroleum & Energy
Physics
Other
3rd AUC Department that was involved (if any)
Please Select
Architecture
Biology
Chemistry
Computer
Construction
Electronics & Communications
Mechanical
Math
Petroleum & Energy
Physics
Other
Briefly describe the role and contribution of each contributor to the development of this innovation
*
0/1500
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Confidential Innovation Disclosure Form
Technical Details about the innovation - Page 2/4
Briefly describe your innovation
*
0/2500
Describe the key aspects of the innovation
*
0/2000
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Market relevant details about the invention - Page 3/4
What is the problem that your innovation solves?
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0/2500
What are the key advantages that your innovation introduces?
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0/2000
When was the innovation first conceived and when and where was it reduced to practice?
0/800
What practical work has been done so far?
*
0/1000
Where do you believe your innovation lies on the technology readiness scale below?
Please Select
1-Basic principle observed
2-Tech concept and/or application formulated
3-Experimental/analytical work on critical component of tech
4-Component validation in lab environment
5-Component validation in relevant environment
6-System/subsystem demonstrated in relevant environment
7-System prototype tested in operational environment
8-Actual system completed and tested for final use
9-Actual system proven by use in market
Do you have plans to further develop this particular innovation towards a market-ready product or service? If yes, please share how you plan to do so.
*
0/1000
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Funding and prior art details - Page 4/4
Are you aware of other literature that describes similar (or competing) technologies?
0/4000
What applications and uses do you envision for the innovation?
*
0/1500
Are you aware of any entities who would be interested in your innovation? If so, please share a list of these with contact details, if available
0/800
How was your Innovation funded?
*
0/600
Please share all keywords you feel would be best used when conducting an online search to identify closely competing innovations
*
0/400
If you disclosed or published anything relevant to the invention, please mention to who, where and what?
*
0/600
Do you have plans to publish?
*
0/400
Are you Human?
*
Please contact the Technology Transfer Office (tto@aucegypt.edu) if you have any questions. By clicking Submit below, all the listed contributors certify that all information provided herein is true and accurate to the best of your knowledge.
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