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Offices of Biotechnology and Business Development

Research Tool Disclosure Form

Biotechnology - Research Tool Input
INVESTIGATOR INFORMATION
Name:
Department:
Building:
Room number:
Phone number:
E-mail address:
Is the principal investigator the technical contact for this research tool? Yes No
RESEARCH INFORMATION
Was this research tool conceived or developed in the performance of the experimental, developmental or research work called for by a federal or private foundation grant? Yes No
* if yes, enter grant number:
Was this research tool conceived or developed in the performance of the experimental, developmental or research work called for by a contract with a private party? Yes No
* if yes, identify party:
Was this reagent developed using materials or technology received under an MTA? Yes No
* if yes, identify the party and state any known restrictions on commercialization:
Were there other collaborators for the development of the reagent? Yes No
* If yes, name them and their institute:.
Reagent name:
Brief description of the reagent:
Benefits and drawbacks of the reagent:
If there are any drawbacks to this reagent, how might they be overcome?
Which companies might have commercial interest in this reagent, and how much might they be willing to pay?
Is the reagent currently available for distribution? Yes No
Why? What needs to be done?
What quantity of the reagent is available for distribution?
Has there been any public disclosure or offer for sale of the reagent? Yes No
Reagent category: Antibody
Assay
Cell line
Gene or protein
Mouse model
Other
REFERENCE INFORMATION
References or prepublication information:
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