General Instructions for the Office of Technology Management
Software and Multimedia Disclosure Form

Thank you for disclosing your software or multimedia Work to the Office of Technology Management (OTM).  The Disclosure Form provides basic information which helps the OTM evaluate, protect, and potentially transfer or commercialize the intellectual property associated with your Work.  If your intention is to make the software available via an Open Source or Academic Use license, please complete the disclosure form and indicate your preference in part 11d.

It is not necessary to answer every question in order to submit this disclosure form. If you do not know an answer, if you have any questions, or would like assistance completing the form, please contact the OTM at (217) 333-7862 (phone); (217) 265-5530 (fax), or OTM@uiuc.edu (email). 

Use the following guidelines while filling out the form: 
•	This form should be filled out either by or in concordance with the Principle Investigator of the disclosing team. If a student is filling out this form, please inform the P.I. before filing.
•	Provide as much information about the technology as possible, citing all relevant sponsorship and publication information.  This enables the OTM and its outside counsel to determine the best method to protect the intellectual property as well as identify possible opportunities for transfer or commercialization of the Work.
•	When identifying creators, use the broadest spectrum possible.

The disclosure form is available in three formats: as an online form, as a .pdf file, or as a downloadable Microsoft Word or .rtf document. Please use whichever format is most convenient for you. If you submit the disclosure form online and would like to include supporting documentation, it can be transmitted electronically along with the form or sent as hardcopies to the OTM through campus mail. 

If you want to send hardcopy printouts of disclosure forms or supporting material, please direct them to: 

Office of Technology Management
319 Ceramics Building, MC-243
105 South Goodwin Avenue
Urbana, Illinois  61801-2901

In addition to sending the form to the OTM, please distribute additional copies to:
•	each Creator
•	Unit Executive Officer(s)

Upon receipt of the completed disclosure form, the OTM will assign it to a technology manager who will arrange an introductory meeting.  The purpose of this meeting will be to acquaint you with the OTM process, gain a more comprehensive understanding of the technology and define next steps. 

1. TITLE

2. CREATORS
List all those who helped contribute to the software.  Please place an asterisk (*) next to the name of the inventor filing this disclosure form.  If any person holds a sole or joint appointment with any other university, company or governmental agency, please note that fact. This form should be filled out either by or in concordance with the Principle Investigator of the disclosing team. If a student is filling out this form, please inform the P.I. before filing.

CREATOR:__________________________________________Dept/Affiliation________________________

CREATOR:__________________________________________Dept/Affiliation________________________

(add spaces as necessary)

3. ABSTRACT OF SOFTWARE WORK

4. SPONSORSHIP
Identify all grants, contracts, and other sources of funds contributing to the research that led to the invention. You should list all agencies that you would acknowledge in a publication.  Be liberal in the interpretation.  The OTM will take care of the contractual reporting obligations associated with your funding.   

Agency or Sponsor	Grant/Contract/Other Number	BANNER/UFAS No.	

			
(add spaces as necessary)

5. ALL KNOWN OWNERSHIP/LICENSING ISSUES RELATED TO FUNDING

6.  TECHNICAL DETAILS OF THE WORK
a. Is this a stand alone product?

b. Hardware Requirements

c. Operating System Requirements

d. Describe User Interface

e. Required Utilities

f. Programming Language

g. Current State of Development

h. Identify any 3rd party code included

I. Required Distribution Format

7. HISTORY OF THE WORK
a. When and where was work on this software completed?

b. Please identify current and previous versions, dates of release, and briefly summarize the differences for each version of the Work.

Version	Release date	Changes from prior versions	

			
(add spaces as necessary)

	c. Is this work currently being used in the research programs of any other group on campus?

8.  PUBLICATIONS/PRESENTATIONS/AND OTHER FORMS OF PUBLIC DISTRIBUTION 
a. Please list all publications concerning this specific software work

b. Please list all individuals outside of the University of Illinois that have received the software
Person	Organization	Date released	Source Code (Y/N)	Version Released	

					
(add spaces as necessary)

9. MARKETING POTENTIAL
a. What commercial software products are most similar to your work?

b. What is the difference between existing software and your software?

c. What are the commercial uses for your software?

10. POTENTIAL USERS
a. Who are the potential end users of your software?

b. Please list any parties currently interested in licensing your software.

c. What industry groups or professional associations include members potentially interested in this work?

d. Are you willing to assist potential licensees with use and future development of the software?

11. FUTURE USE
a. Do you think this software is patentable?

b. Do you think this software could provide a foundation for the formation of a start-up company?

c. Do any of the creators have interest in starting up a company to further develop, market, and support the software? If so, who?

d. Do you want this software to be made available through Open Source or Academic Use licensing? If so, please complete the box below.

Reasons for Open Source or Academic Use licensing