Please Email the Completed Inventor Data Sheet to

INVENTOR DATA SHEET

Please email the completed Inventor Data Sheet to [email protected]. Title of Invention:

Contribution: Briefly describe your contribution to the disclosed technology.

Inventor: First: MI: Last: Ms. Mrs. Mr.

PhD DVM MD MS/MA BS/BA Other: Please name any joint appointments and/or affiliation that you have with another institution, including but not limited to joint appointments within TAMUS (if any):

University ID Number (UIN): Country of Citizenship:

Work Address: Home Address: street address street address city/state/zip city/state/zip phone phone fax fax work email home email

TAMUS Employment Status/Title (including former employees):

Professor Associate Professor Assistant Professor Employed Student

Other Status/Title (if not listed above):

Former Texas A&M University System Employee If you checked “Former Texas A&M University System Employee,” were you employed by the A&M System at the time of technology or discovery? YES NO

TAMUS Member (AgriLife, TAMU, TEES, TTI, TAMU-Kingsville, TAMU-Corpus Christi, etc.): Department/Division: Laboratory or Center: Non-TAMUS Employment Status/Title (for non-TAMUS inventors only): Please provide your Position/Title and Company Name:

Form Revised 09/07/2016 Form Revised 09/07/2016