Idea Submission Form

This is an important first step in documenting your idea and gaining possible protection and licensing. With the information you provide, we will evaluate your invention’s commercial potential and our ability to secure patent protection.

If you think you have a patentable invention, or even an interesting idea, fill out the information below and our office will begin the evaluation process. If you have any questions please contact innovations@northwell.edu.

Question Title

* 1. Title of Invention

Question Title

* 2. First and Last Name

Question Title

* 3. Title

Question Title

* 5. Department/Specialty

Question Title

* 6. Department Head

Question Title

* 7. Office Phone Number

Question Title

* 8. Mobile Phone Number

Question Title

* 9. Primary Email Address

Question Title

* 10. Secondary Email Address 

Question Title

* 11. Description of Invention

Question Title

* 12. Type of Invention 

Question Title

* 13. Invention Stage

Question Title

* 14. Type of Patent Application Filed (If Applicable) 

Question Title

* 15. Patent and/or Application Number

Question Title

* 16. Intended Specialty of the Idea  (Check all that apply) 

Question Title

* 17. Unmet Need: Describe how the idea proposes to address an unmet need or problem

Question Title

* 18. Funding Source

Question Title

* 19. If yes, was this funded by a federal grant agency?

Question Title

* 20. If yes, please enter Funding Institution Grant No(s).

Question Title

* 21. Public Disclosure

Question Title

* 22. If Yes, Type of Public Disclosure 

Question Title

* 23. Date(s) of Public Disclosure

Question Title

* 24. Please attach file here (no larger than 16MB)

DOCX, DOC, JPG, JPEG, PDF, PNG file types only.
Choose File
No file chosen

T