PO Box 6000, Binghamton, N
Y
, 13902-6000. Ph: (607) 777-5870.
FORM TT-2
Revised 9/07/06
FORM
TT - 2
Technology Transfer
DIVISION OF RESEARCH
State University of New York at Binghamton
NEW TECHNOLOGY DISCLOSURE
PLEASE SUBMIT COMPLETED FORM TO CAMPUS RESEARCH OFFICE
1. CAMPUS SUBMITTING THIS DISCLOSURE:
2. TITLE:
3. KEY WORDS:
4. TYPE:
Invention
Other
5. PRIMARY CONTACT (among developers/inventors) :
6. DATE OF CONCEPTION:
7. SPONSORSHIP:
United States Government
Private Industry
SUNY
Personal
Other
S.No.
Name of Sponsor(s) &
Funding Agreement Number
Research Foundation
(or)
Campus Account Number
Sponsored Assigned
Identification Number
8. PUBLIC DISCLOSURE:
a. Has the description of the technology been published?
Yes
No
Date:
Has the description of the technology been submitted for publication?
Yes
No
Date:
Title of the Publication:
Software
Video
b. Has the technology been presented at a conference or professional
meeting?
Title of the Journal/Other (specify):
Yes
No
Date:
Print Form
PO Box 6000, Binghamton, N
Y
, 13902-6000. Ph: (607) 777-5870.
FORM TT-2
Revised 9/07/06
9. BRIEF TECHNICAL CONFIDENTIAL DESCRIPTION (including its unique features):
(Attach any manuscripts, reviews, papers, diagrams, charts, etc.)
10. PROTOTYPES AND/OR SAMPLES:
a. Is a working prototype available for demonstration?
Yes
b. Are samples (e.g. compounds) available for testing?
11. ADVANTAGES OF THE TECHNOLOGY
(relative to existing technology):
No
N/A
N/A
No
Yes
PO Box 6000, Binghamton, N
Y
, 13902-6000. Ph: (607) 777-5870.
FORM TT-2
Revised 9/07/06
12. POSSIBLE DISADVANTGES OF THE TECHNOLOGY
(relative to existing technology):
13. NON-CONFIDENTIAL DESCRIPTION OF THE TECHNOLOGY:
(indicate applications and advantages - for marketing purposes)
14. LIST COMPANIES THAT YOU BELIEVE WOULD BE INTERESTED IN COMMERCIALIZING THE TECHNOLOGY:
S.No.
Company Name
Contact (if any)
Location / Telephone Number
15. SIGNATURE OF DEVELOPER(S) AND WITNESS(ES): (Attach additional sheets if necessary)
a. Name:
Title:
Developer's Signature:
Country of Citizenship:
Witness's Signature:
Date:
Home Address:
Home Telephone:
Campus Address:
Campus Telephone:
Campus Fax Number:
b. Name:
Title:
Developer's Signature:
Country of Citizenship:
Witness's Signature:
Date:
Home Address:
Home Telephone:
Campus Address:
Campus Telephone:
Campus Fax Number:
c. Name:
Title:
Developer's Signature:
Country of Citizenship:
Witness's Signature:
Date:
Home Address:
Home Telephone:
Campus Address:
Campus Telephone:
Campus Fax Number:
d. Name:
Title:
Developer's Signature:
Country of Citizenship:
Witness's Signature:
Date:
Home Address:
Home Telephone:
Campus Address:
Campus Telephone:
Campus Fax Number:
e. Name:
Title:
Developer's Signature:
Country of Citizenship:
Witness's Signature:
Date:
Home Address:
Home Telephone:
Campus Address:
Campus Telephone:
Campus Fax Number:
Binghamton University
Division of Research
Innovative Technologies Complex
P.O. Box 6000
Binghamton, NY 13902-6000
Telephone: (607) 777-5870
Fax: (607) 777-5788
hsegrue@binghamton.edu
FOR TTO USE ONLY
Date Disclosure Received:
Date of Complete Disclosure:
PO Box 6000, Binghamton, N
Y
, 13902-6000. Ph: (607) 777-5870.
FORM TT-2
Revised 9/07/06