CRICOS Provider No. 00103D | RTO Code 4909

The purpose of this form is to officially notify the University of IP that has been developed. The form also serves to establish a legal record of the date of conception of the IP. All creators must provide detailed and accurate information to enable a fair assessment of the ownership, commercial potential and protection that might be applicable to that IP.

Lead IP Creator/s A Creator is an individual without whose intellectual and creative input the IP could not have been made in its present form. They must have conceived or contributed an essential element of the IP independently or jointly with others, during the evolution of the IP or its reduction to practice. The co-authors of publications are not necessarily inventors.
Name	Position	Dept/School (Org if external)	Email	Student Y/N

Contributors An individual not considered a creator but has contributed to the development of the IP.
Name	Position	Dept/School (Org if external)	Email	Student Y/N

(copy table and submit on a separate page if more people are involved)

Intellectual Property Description
3.1. What is the stage of development of the IP?
Idea/concept (target identification)
Early stage (target assay development and screening)
Proof of concept (target validation)
Bench prototype
Industry interest/use
3.2. What date(s) did you make the IP? The date is when the creator(s) devised the essential concepts of the IP – but without necessarily having provided that it would work or having built a prototype

3.3. What is the problem solved by this IP? Do not describe the IP but instead focus on the problem found with existing technology, processes or services, or a recognised problem not adequately solved by existing technologies, processes or services
3.4. Summary of the IP Describe the IP in detail. Consider the commercial applications of the technology and how they might be applied to a product, process or service. Describe what aspects of the IP have been proven experimentally and what is shown by the data. Also describe what materials or prototypes have been created in relation to the IP. Attach any technical documents of IP including (submitted or draft) manuscripts, postes, theses and grant applications.
3.5. Competitive Advantage What is the closest existing or known technology? What are the advantages and benefits of your IP over these competitor approaches?
3.6. Future Research What future research will be conducted over the next 12 months to demonstrate proof of concept or further validate the IP?

Public Disclosures Provide details of any public disclosures of this IP by contributors including publications, theses, posters, presentations, abstracts, submitted manuscripts and patents. Consider whether any details of any of your research have been disclosed publicly and provide brief details of the disclosure subject matter. For any noted disclosures: Attach any relevant disclosure documents If students where involved, please include details of any material or presentations made for examination

Potential IP Encumbrances
Was the IP developed using any research grants/contract funds? (Y/N)
Research Project Name	Project Number	IP Use (created or used as background)
5.1. Obligations to Funding Bodies Are you aware of any obligations to any funding bodies e.g. disclosure of IP, final project reports, or commercial grant of rights (option/licences)?

Commercialisation Opportunities
6.1. Market Information Please list companies you have existing relationships with, you have contacted or those that you believe would be interested in your product.
Company	Contact Details	Scope of interest and/or relevance to IP

Conflict of Interest Please list any facts or circumstances related to this IP that might create a conflict of interest, or that might be perceived as a conflict of interest.

Declaration I have discussed this intellectual property with my relevant Dean or equivalent I have discussed the content of this intellectual property disclosure and obtained consent for its submission with my co-creator/s and co-contributor/s I acknowledge and agree that to the best of my knowledge this information provided is true and correct
Signature of staff member or student	Date
Signature of Dean or equivalent	Date

Submit form to director.research@federation.edu.au