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.

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* 1. Title of Invention

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* 2. First and Last Name

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* 3. Title

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* 5. Department/Specialty

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* 6. Department Head

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* 7. Office Phone Number

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* 8. Mobile Phone Number

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* 9. Primary Email Address

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* 10. Secondary Email Address 

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* 11. Description of Invention

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* 12. Type of Invention 

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* 13. Invention Stage

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

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* 15. Patent and/or Application Number

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

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

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* 18. Funding Source

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

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

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* 21. Public Disclosure

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* 22. If Yes, Type of Public Disclosure 

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* 23. Date(s) of Public Disclosure

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

DOCX, DOC, JPG, JPEG, PDF, PNG file types only.
Choose File

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