Applicant University
University Name:
Address One:
Address Two:
City:
State:
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Zip:
County:
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Country Other County in PA Other State
in U.S.
Municipality:
-
Select County First -
Web Site:
Primary Contact
Title: -None- Dr. Honorable Miss Mrs. Mr. Ms. Prof.
First Name:
Middle Name:
Last Name:
Suffix:
-None- Esq. III II IV I Jr. M.D. Ph.D. Sr. V
Department:
Phone Number:
(
Fax Number:
(
E-Mail:
Technology Status
Please provide a brief description of the current status of the technology.
Name of Inventor:
Anticipated market application of the technology:
Intellectual property status:
Use of Funding
Please provide a brief description of the intended use of IW funding.
Anticipated activities:
Describe the purpose or goals of the activities with respect to helping to determine the technology's commercialization potential:
Estimated completion date:
Terms and Agreements
Innovation Works is a non-profit economic development agency serving the citizens of southwestern Pennsylvania. If we agree to provide you with business assistance, we will do so at no charge to you. We disclaim (and you waive) all warranties related to the assistance we may provide to you, and you also agree that neither Innovation Works, its directors, officers, employees nor agents shall be liable to you for any damages, including, without limitation, loss of profit or business opportunity.
