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I am applying on behalf of: * An Organization/Business A Nonprofit Salutation: * Mr. Ms. Mrs. Dr. First Name * Middle Name * Last Name * Address * Phone * Email * Organization/Company Name * Organization Phone * Organization Email * Organization Address (city) * Organization Address (state) * Organization Address (zip code) * Organization Address (country) * Is the organization currently under an obligation to assign (i.e. sell) the patent to any other entity? * Yes No If Organization/Business selected above: Is your company formally incorporated/formed? * Yes No Estimated gross revenue for current fiscal year: * What kind of company? * LLC S-Corp C-Corp Oher Briefly describe the nature of the business: * If Nonprofit selected above: Is the Non-Profit already registered as a 501(c)(3)? * Yes No How many inventors will be listed on the patent? * 1 2 3 4 Only Non-Profits/Small Business may use this application. If you are a solo inventor, you must use the Solo Inventor Application here. Inventor 1 First Name * Inventor 1 Last Name * Inventor 1 Phone * Inventor 1 Email * Inventor 1 Address (city) * Inventor 1 Address (state) * Inventor 1 Address (postal code) * Inventor 1 Address (country) * What is Inventor 1's role within the organization? * To the best of your knowledge, has Inventor 1 been listed as an inventor on any other patent/pending application (other than a provisional covering the present invention)? * Yes No If Yes, then: How many patents/pending applications has Inventor 1 been listed on? * 1-3 4+ We cannot accept cases where any inventor has been listed on more than 4 previous patents/pending applications unless the inventor has already assigned the patent(s) to a previous employer. You will need to demonstrate such an assignment during the intake appointment. How has Inventor 1 satisfied the mandatory training requirement? * Attended a Patent 101 Seminar Completed the USPTO Online Training I have not satisfied the requirement Inventor 2 First Name * Inventor 2 Last Name * Inventor 2 Phone * Inventor 2 Email * Inventor 2 Address 1 (city) * Inventor 2 Address (state) * Inventor 2 Address (postal code) * Inventor 2 Address (country) * What is Inventor 2's role within the organization? * To the best of your knowledge, has Inventor 2 been listed as an inventor on any other patent/pending application (other than a provisional covering the present invention)? * Yes No If Yes, then: How many patents/pending applications has Inventor 2 been listed on? * 1-3 4+ We cannot accept cases where any inventor has been listed on more than 4 previous patents/pending applications unless the inventor has already assigned the patent(s) to a previous employer. You will need to demonstrate such an assignment during the intake appointment. How has Inventor 2 satisfied the mandatory training requirement? * Attended a Patent 101 Seminar Completed the USPTO Online Training I have not satisfied the requirement Inventor 1 First Name * Inventor 1 Last Name * Inventor 1 Phone * Inventor 1 Email * Inventor 1 Address (city) * Inventor 1 Address (state) * Inventor 1 Address (postal code) * Inventor 1 Address (country) * What is inventor 1's role within the organization? * To the best of your knowledge, has Inventor 1 been listed as an inventor on any other patent/pending application (other than a provisional covering the present invention)? * Yes No If Yes, then: How many patents/pending applications has Inventor 1 been listed on? * 1-3 4+ We cannot accept cases where any inventor has been listed on more than 4 previous patents/pending applications unless the inventor has already assigned the patent(s) to a previous employer. You will need to demonstrate such an assignment during the intake appointment. How has Inventor 1 satisfied the mandatory training requirement? * Attended a Patent 101 Seminar Completed the USPTO Online Training I have not satisfied the requirement Inventor 2 First Name * Inventor 2 Last Name * Inventor 2 Phone * Inventor 2 Email * Inventor 2 Address (city) * Inventor 2 Address (state) * Inventor 2 Address (postal code) * Inventor 2 Address (country) * What is inventor 2's role within the organization? To the best of your knowledge, has Inventor 2 been listed as an inventor on any other patent/pending application (other than a provisional covering the present invention)? * Yes No If yes, then: How many patents/pending applications has Inventor 2 been listed on? * 1-3 4+ We cannot accept cases where any inventor has been listed on more than 4 previous patents/pending applications unless the inventor has already assigned the patent(s) to a previous employer. You will need to demonstrate such an assignment during the intake appointment. How has Inventor 2 satisfied the mandatory training requirement? * Attended a Patent 101 Seminar Completed the USPTO Online Training I have not satisfied the requirement Inventor 3 First Name * Inventor 3 Last Name * Inventor 3 Phone * Inventor 3 Email * Inventor 3 Address 1 (city) * Inventor 3 Address (state) * Inventor 3 Address (postal code) * Inventor 3 Address (country) * What is inventor 3's role within the organization? * To the best of your knowledge, has Inventor 3 been listed as an inventor on any other patent/pending application (other than a provisional covering the present invention)? * Yes No If yes, then: How many patents/pending applications has Inventor 3 been listed on? * 1-3 4+ We cannot accept cases where any inventor has been listed on more than 4 previous patents/pending applications unless the inventor has already assigned the patent(s) to a previous employer. You will need to demonstrate such an assignment during the intake appointment. How has Inventor 3 satisfied the mandatory training requirement? * Attended a Patent 101 Seminar Completed the USPTO Online Training I have not satisfied the requirement Inventor 1 First Name * Inventor 1 Last Name * Inventor 1 Phone * Inventor 1 Email * Inventor 1 Address (city) * Inventor 1 Address (state) * Inventor 1 Address (postal code) * Inventor 1 Address (country) * What is inventor 1's role within the organization? * To the best of your knowledge, has Inventor 1 been listed as an inventor on any other patent/pending application (other than a provisional covering the present invention)? * Yes No If Yes, then: How many patents/pending applications has Inventor 1 been listed on? * 1-3 4+ We cannot accept cases where any inventor has been listed on more than 4 previous patents/pending applications unless the inventor has already assigned the patent(s) to a previous employer. You will need to demonstrate such an assignment during the intake appointment. How has Inventor 1 satisfied the mandatory training requirement? * Attended a Patent 101 Seminar Completed the USPTO Online Training I have not satisfied the requirement Inventor 2 First Name * Inventor 2 Last Name * Inventor 2 Phone * Inventor 2 Email * Inventor 2 Address (city) * Inventor 2 Address (state) * Inventor 2 Address (postal code) * Inventor 2 Address (country) * What is inventor 2's role within the organization? * To the best of your knowledge, has Inventor 2 been listed as an inventor on any other patent/pending application (other than a provisional covering the present invention)? * Yes No If Yes, then: How many patents/pending applications has Inventor 2 been listed on? * 1-3 4+ We cannot accept cases where any inventor has been listed on more than 4 previous patents/pending applications unless the inventor has already assigned the patent(s) to a previous employer. You will need to demonstrate such an assignment during the intake appointment. How has Inventor 2 satisfied the mandatory training requirement? * Attended a Patent 101 Seminar Completed the USPTO Online Training I have not satisfied the requirement Inventor 3 First Name * Inventor 3 Last Name * Inventor 3 Phone * Inventor 3 Email * Inventor 3 Address (city) * Inventor 3 Address (state) * Inventor 3 Address (postal code) * Inventor 3 Address (country) * What is inventor 3's role within the organization? * To the best of your knowledge, has Inventor 3 been listed as an inventor on any other patent/pending application (other than a provisional covering the present invention)? * Yes No If Yes, then: How many patents/pending applications has Inventor 3 been listed on? * 1-3 4+ We cannot accept cases where any inventor has been listed on more than 4 previous patents/pending applications unless the inventor has already assigned the patent(s) to a previous employer. You will need to demonstrate such an assignment during the intake appointment. How has Inventor 3 satisfied the mandatory training requirement? * Attended a Patent 101 Seminar Completed the USPTO Online Training I have not satisfied the requirement Inventor 4 First Name * Inventor 4 Last Name * Inventor 4 Phone * Inventor 4 Email * Inventor 4 Address (city) * Inventor 4 Address (state) * Inventor 4 Address (postal code) * Inventor 4 Address (country) * What is inventor 4's role within the organization? * To the best of your knowledge, has Inventor 4 been listed as an inventor on any other patent/pending application (other than a provisional covering the present invention)? * Yes No If yes,then: How many patents/pending applications has Inventor 4 been listed on? * 1-3 4+ We cannot accept cases where any inventor has been listed on more than 4 previous patents/pending applications unless the inventor has already assigned the patent(s) to a previous employer. You will need to demonstrate such an assignment during the intake appointment. How has Inventor 4 satisfied the mandatory training requirement? * Attended a Patent 101 Seminar Completed the USPTO Online Training I have not satisfied the requirement Title of Invention * Basic subject area: * Bio/lifesciences Ornamental Design Mechanical Chemical Electrical/Computer Other Do you have a provisional application on file with the USPTO? * Yes No If yes then provide the application no: * Provide the filing date: * *If current date is more than 6 months from the filing date of provisional.*• Due to timing constraints for filing the non provisional application the Penn State Law, Intellectual Property Clinic is unable to screen and place your application before the expiration of your provisional application . You may want to review the resources on the USPTO site for filing you appeal pro se (on your own) https://www.uspto.gov/patents-getting-started/using-legal-services/pro-se-assistance-program Otherwise, continue Briefly describe the basis for your invention (please limit explanation to what you believe to be your invention and the improvement over the existing prior art) * Limit the description to 750 words or less. Are all of the inventors currently under a contractual obligation to assign the patent to the organization? * Yes No Have you completed a prior art search? * Yes No DISCLOSURES: By submitting my electronic signature below, and by submitting this application, I am making the following representations: 1. The information provided by me in this application is, to the best of my knowledge, compete and accurate. 2. I understand that submitting false or misleading information may result in delay or denial of services. 3. I understand that misrepresenting the financial information used to establish my qualification for micro-entity status to the United States Patent and Trademark Office may constitute fraud, and could result in the invalidation of the patent or application. 4. I will notify the Penn State Law, Intellectual Property Clinic program if any of the information in this application materially changes prior to placement with an attorney, especially if any inventor's income should suddenly increase. 5. I have not shared any confidential details of my invention, other than the provisional patent application number, with the Penn State Law, Intellectual Property Clinic. 6. I understand that continuation in the program is at the discretion of the program administrator, and that filling out this application does not entitle me to any services. 7. I agree and understand that this application does not create an attorney-client relationship between any named inventor or myself and any individual attorney, the Penn State Law, Intellectual Property Clinic. 8. I understand that the Penn State Law, Intellectual Property Clinic is limited to screening the application. If approved by the Penn State Law, Intellectual Property Clinic, they will provide my information to the IP Section of the Pennsylvania Bar Association for matching. 9. I understand that the Penn State Law, Intellectual Property Clinic is responsible with placing the matter with either a patent attorney or patent agent, and that this person's representation may be limited to the filing of the application. 10. I understand that successful screening of the application does not guarantee that I will be matched with a patent attorney or patent agent. 11. I understand that Penn State Law, Intellectual Property Clinic’s scope of services are limited to the screening of applicants, if I have another legal issue prior to placement with a patent attorney/agent, Penn State Law, Intellectual Property Clinic will not handle the placement of these issues. I further understand that while my assigned attorney may take on these additional matters, they may charge additional fees for these services. 12. I understand that the applicant remains responsible for the payment of all necessary governmental fees and ancillary fees when necessary. Electronic Signature and Date Stamp * After submitting this application, the program administrator will review the details and will attempt to contact you within a reasonable period of time. Please only call the office or e-mail for confirmation if you do not receive an automated confirmation e-mail. Keep in mind that the office is usually closed on and around major holidays, and delays are likely during these periods of the year Please review your application carefully before submitting. Submitting your application multiple times will cause unnecessary delays. We ask you to please be certain of your responses before pressing the submit button. If you need to make material changes after hitting submit, please e-mail us at IPClinic@pennstatelaw.psu.edu, but DO NOT submit and then go back to make changes and submit again. Leave this field blank
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