Engagement Request Form 

The information collected on this form will facilitate a prompt, conditional review of ideas and/or works of authorship conceived and/or authored by University faculty, staff and students. Please submit this form using the button at the bottom of the page. A licensing manager will contact you to complete a detailed assessment of your idea, and to gather additional information used by the University to fulfill its reporting obligations to external sponsors. If this form constitutes an enabling disclosure, it will constitute disclosure and no additional material will be required.

Please complete this section to help identify any previous or upcoming public disclosures which could affect our ability to seek the broadest possible protection of your idea. Public disclosures include but are not limited to publications, abstracts, posters and oral presentations at meetings, website publication, grand rounds, awarded grants, and third party discussions. Presentations to University personnel are not considered public disclosures provided that non-University personnel are not in attendance. If you have any questions about what constitutes a public disclosure, please contact us.

Has the subject matter of your idea been publicly disclosed? If so, provide the date and a citation or reference.

Please include the date of previous public disclosure, if any.

If there has been no public disclosure, is there an anticipated date of such disclosure? If so, provide the anticipated date.

Please hold down Control and click to select multiple files.

Sources of Funding

Identify all sources of funding used in the conception, creation or reduction to practice of your idea.

Funding Type Grant/Contract # Comments, Funder Name

Other Contributors