Invention Disclosure Form Template

Company / Organization Name: [Company Name]
Department: [Department Name]
Form Date: [Date]
Reference Number: [Reference Number, if applicable]

1. Invention Information

Invention Title: [Title of Invention]
Short Description: [Brief summary of the invention]
Type of Invention: [Product / Process / Method / Software / Device / Formula / Other]

2. Inventor Information

Inventor 1 Name: [Full Name]
Job Title: [Job Title]
Department: [Department]
Email Address: [Email Address]

Inventor 2 Name: [Full Name]
Job Title: [Job Title]
Department: [Department]
Email Address: [Email Address]

Additional Inventors, if any:

[Insert names and roles]

3. Description of the Invention

Describe the invention in clear terms:

[Explain what the invention is, how it works, and what makes it useful]

Main features or components:

[Feature 1]
[Feature 2]
[Feature 3]

4. Problem Solved

The invention is intended to solve the following problem or improve the following process:

[Describe the problem, limitation, or business need]

5. Novelty and Advantages

What makes this invention new or different?

[Describe what is unique, improved, or different from existing products, methods, or systems]

Advantages of the invention:

[Advantage 1]
[Advantage 2]
[Advantage 3]

6. Development Timeline

Date first conceived: [Date]
Date first reduced to practice: [Date]
Current stage of development:

☐ concept only
☐ prototype
☐ tested
☐ in use internally
☐ ready for further review
☐ other: [Describe]

7. Public Disclosure and Use

Has the invention been publicly disclosed, shared, demonstrated, published, offered for sale, or used outside the organization?

☐ yes
☐ no

If yes, provide details:

[Describe date, audience, event, publication, sale, or other disclosure]

8. Third-Party or Funding Information

Was any outside party involved in the development of this invention?

☐ yes
☐ no

If yes, provide details:

[Name of contractor, consultant, partner, university, client, or other party]

Was any grant, sponsorship, or outside funding used?

☐ yes
☐ no

If yes, provide details:

[Describe funding source or agreement]

9. Related Materials

Related documents or materials attached, if any:

☐ drawings
☐ technical notes
☐ prototype photos
☐ source code or software summary
☐ lab records
☐ testing results
☐ other: [Describe]

10. Commercial or Business Value

Potential use, business application, or market value of the invention:

[Describe possible internal use, licensing value, customer use, or commercial opportunity]

11. Additional Notes

Additional comments relevant to ownership, development, contributors, prior ideas, or review:

[Insert notes]

12. Inventor Certification

I certify that the information provided in this form is true and complete to the best of my knowledge and that all known inventors or contributors have been identified as appropriate.

Inventor Signature: __________________________
Name: [Full Name]
Date: [Date]

Additional Inventor Signature: __________________________
Name: [Full Name]
Date: [Date]

13. Internal Review

Reviewed By: [Full Name]
Title: [Job Title]
Department: [Legal / IP / Management / Other]
Review Date: [Date]

Review Notes:

[Insert internal review notes]

Decision or Status:

☐ pending review
☐ additional information needed
☐ approved for further review
☐ not approved at this time
☐ other: [Describe]