Faculty Nominee University/Nominator

Ohio Faculty Council Faculty Commercialization Award 2017 Nomination Form

A. OVERVIEW

1) Provide a clear and concise layman’s description of the licensed technology

2) Describe benefits to society; identify the problem(s) being solved, noting potential applications, fields of use

3) Faculty engagement pre-licensing; role of the faculty member, steps taken in advancing the technology to licensing (include key steps, hurdles, solutions)

4) Faculty engagement post-licensing; role of the faculty member, steps taken in advancing the technology to licensing (include key steps, hurdles, solutions)

5) Describe how the faculty member’s work contributes to advancing a culture of innovation and entrepreneurship within the State and expands future research opportunities for Ohio universities.

B. PROGRESS TO DATE

1) Summary of path to market a. Brief Overview b. Start-up or existing company? c. Initial product d. Initial market e. Defined benchmarks

2) Has the technology been supported by outside investment during its development? a. Contract research support Yes☐ No☐ b. SBIR (Phase I) awards Yes☐ No☐ c. SBIR (Phase II) awards Yes☐ No☐ d. Equity investment Yes☐ No☐ e. Loans Yes☐ No☐ f. Additional comments

3) Licensing agreement a. Licensing agreement revenue to nominating institution to date b. Were patent and/or copyright costs recovered as part of the fees to the institution? (If yes, what amount from 3a are those costs?)

1 Faculty Nominee University/Nominator

c. Does the licensing agreement allow for exclusive use or could there be additional licensees? d. Anticipated licensing fees to be paid over the life of the agreement

4) Initial product (post licensing agreement) a. Is a product or service available? Yes☐ No☐ b. If yes, how many sales have been made to date and to how many customers? c. Additional comments

5) Future business activities a. Products b. Markets c. Timetable / Benchmarks d. What is the role of the lead researcher in supporting the commercialization effort post-licensing?

6) Impact on Ohio’s economy a. Is the current product or service produced within Ohio? b. How many jobs (especially high-paying jobs) have been and will be created? c. Are there or will there be synergistic collaborations with other colleges or universities (public or private) or companies in Ohio, nationally, or internationally? d. Additional comments

C. CLOSING / Additional comments

Attachments Product-specific documents and marketing plans are not required but will be accepted. List attachments here:

E-Mail completed forms to the Chair of the Ohio Faculty Council: [email protected]

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