Instructions for the Invention Disclosure Form

Following is a description of each section of the Invention Disclosure Form:

Section 1: The Invention

Title of invention.  Please note that this does not necessarily need to be the final title on the patent application.

Section 2: Role and Contributions by You and Others to this Invention

Give the following information for each inventor:

  • Full name
  • Hospital/department
  • Business phone
  • Mobile phone
  • Business fax
  • Primary e-mail
  • Secondary e-mail
  • Home address
  • Citizenship

Note: It is important for you to identify each individual who played a role in the creation of the invention you are disclosing.  Inventorship eventually will be determined by outside patent counsel for the Feinstein Institute.  You will be given an explanation of the process of determining inventorship and the opportunity to speak with our counsel about your role and the role of others, and you will be informed of counsel’s determination of inventorship before the filing of a patent application. Home address and citizenship information will be needed to complete a patent application.

Section 3: Contributions of other Organizations, including Granting Agencies

  • List personnel, money, and/or materials.
  • If this work was supported by a grant or contract, indicate the funding agency and grant number. This information is very important as the Office of Technology Transfer has an obligation to report any and all inventions which result from government grant support. For more information see https://grants.nih.gov/grants/bayh-dole.htm
  • If material was obtained under the terms of a Material Transfer Agreement (MTA), give details including company or university scientist and date of agreement.
  • List any other contributions or resources such as use of shared facilities etc.

Section 4: Description of Invention

Sketches, prints, photos, block diagrams and any pertinent manuscript should be attached to this disclosure. Manuscripts generally following this outline are acceptable substitutes.

  • Please describe the invention in as much detail as possible.
  • Describe the key and novel features that distinguish this invention from others that are currently available.
  • Describe the applications of this device and list any potential problems it may solve.
  • Describe the advantages of this device over other devices that are currently available.

Section 5:  Invention Classification

a) Please choose the research area(s) that best applies to the invention. Check all that apply

b) Please select the type of invention that best described this invention.

Section 6: Documentation

  • When did you first think of the invention? Did you document it by text, sketch, drawing or the like in a notebook or dated record?
  • When did you first reduce the invention to practice? Did you document it by text, sketch, drawing or the like in a notebook or dated record?

Section 7: Commercial Possibilities

Discuss potential commercial applications of this invention.  Information about the market size and pricing of comparable technologies would be especially useful.

Section 8: Industry Contacts

List any industry contacts with whom you have discussed, or would like to discuss, commercialization of this invention, or who may be interested in sponsoring future research. Include name, company/affiliation, title and contact information.

Section 9: Publications or Presentations

Please list the titles and dates of relevant publication(s) authored by you or your colleagues pertaining to the invention.  These include publications on websites, publication of abstracts, poster presentations, and showings at conferences.  Please attach copies of submitted or published versions. Please note: many journals and scientific societies often make material available online in advance of the printed publication or meeting. Valid patent protection depends on accurate dates of public disclosure.

Section 10: Execution of Disclosure

The disclosure should be signed and dated by the inventor(s).

Section 11: Submission

Submit the disclosure to:
Kirk R. Manogue, PhD
Vice President, Office of Technology Transfer
The Feinstein Institute for Medical Research

Administrative Offices

125 Community Drive
Great Neck, NY 11021
Phone: 516-465-2733
kmanogue@northwell.edu