1. OFFICE OF TECHNOLOGY COMMERCIALIZATION Title of Invention Invention Disclosure Form Date Name Department School CONFIDENTIAL

2. OFFICE OF TECHNOLOGY COMMERCIALIZATION Information in this report is supplied by the investigators pursuant to obligations of researchers specified in Rowan University Intellectual Property Policy for University Research. Timely disclosure of Federally funded research is required by Federal Law under the Bayh Dole Act, 37 CFR 401.14(c) If you have questions completing this document, please contact the Director of Intellectual Property, Mina Zion at x5097 or email at Zion@rowan.edu. Please distribute copies to all individuals who worked on this invention as identified in the inventor distribution section of this document. Please provide publications, technical data and other supporting documents in separate attachments upon delivering this document. Zion@rowan.edu CONFIDENTIAL

3. OFFICE OF TECHNOLOGY COMMERCIALIZATION Invention Abstract. Functional purpose of invention: Industry and companies most likely to benefit from invention: Current State of Art – How is technology currently being used: CONFIDENTIAL

4. OFFICE OF TECHNOLOGY COMMERCIALIZATION Prior Art. How is invention different from existing technologies: How is invention superior to existing technologies: CONFIDENTIAL

5. OFFICE OF TECHNOLOGY COMMERCIALIZATION Conception of invention. Date of conception: Physical location of conception: Parties involved in conceiving, developing, refining and/or proving invention: First/Middle/Last, Title, Department, Company/University, Citizenship, Phone CONFIDENTIAL

6. OFFICE OF TECHNOLOGY COMMERCIALIZATION Disclosure. Names all parties who have proprietary, confidential knowledge of invention: Name all parties who you expect will have such knowledge: CONFIDENTIAL

7. OFFICE OF TECHNOLOGY COMMERCIALIZATION Project Funding. Names all sources of Federal Funding, include Grant/Contract/Agreement Number: Name all sources of Non-Federal Funding, include Grant/Contract/Agreement Number: CONFIDENTIAL

8. OFFICE OF TECHNOLOGY COMMERCIALIZATION Other agreements relevant to this invention file. Identify all agreement types and parties relating to this invention: Agreement TypeOther Parties to Agreement and Description Material Transfer Agreement Confidentiality Agreement Collaboration Agreement Research Agreement Consortia Agreement Consulting Agreement Other CONFIDENTIAL

9. OFFICE OF TECHNOLOGY COMMERCIALIZATION Submit to the Office of Technology Commercialization. zion@rowan.edu 856-256-5097 CONFIDENTIAL