A. INVENTION DISCLOSURE FORM
Date: 
Basic Information
1. Name: 
2. Official title or position:
3. Title or brief description of invention:
4. Grant award or contract number under which work was done leading to invention (if any): 
5. If the work was done under a grant, contract, or consulting agreement, attach a copy of any pertinent legal documents.
6. Name and address of facility in which invention was made:
Contributors
1. List the full name, home address, and citizenship of anyone who contributed to the initial concept for the research leading to the invention:
2. List the ...
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