Part I: License Application and Business Terms

NASA Marshall Space Flight Center Part I: License Application and Business Terms

NASA has the authority to grant licenses pursuant to 35 USC §§207-209. NASA follows the regulations set forth in 37 CFR §404. All NASA licenses are individually negotiated and each license contains terms concerning technology transfer (practical application), license duration, royalties, and periodic reporting—information that constitutes the business terms of the license. Please do not submit a license application without first discussing your needs with a Marshall technology transfer representative. The license application process takes place in two stages to expedite the license agreement negotiation process. In the first stage, the applicant documents their proposed business terms following the guidelines in this document, Part I: License Application and Business Terms. Along with the proposed business terms, the applicant submits a five-year income pro forma. The pro form data is a “best guess” on the applicant’s part for the expected revenue and sales of the licensed technology. The applicant can use the pro forma to help calculate the proposed licensing fees paid to NASA.

Once the business terms are agreed to by NASA and the applicant, the applicant will complete the second stage of the license application process, following the guidelines found in Part II: Commercialization Plan and Milestones. The applicant must submit the commercialization plan to complete the license application process. All the information provided in the final Part I: License Application and Business Terms and Part II: Commercialization Plan and Milestones documents will be included as an appendix to the license agreement. All information submitted in the both Parts I and II of the license process will be maintained in confidence by NASA and will not be subject to disclosure under the Freedom of Information Act.

A. Technology Information NASA Case Number(s): Title(s): Patent Number(s), Name(s), Issue Date(s): Invention Description: Software Involved? ( ) yes () no Software Usage Agreement Required? ( ) yes () no

License Application from | Page 1 of 4 B. Type and Scope of License Grant of License: NASA would grant to Company, a revocable, royalty-bearing, license to the NASA Technology. Type of License Requested: ( ) Exclusive ( ) Non-Exclusive ( ) Partially-Exclusive Fields of Use Requested: If partially-exclusive, specify field(s) of use or geography(ies):

Sublicense Rights: ( ) Requested (usually only for Exclusive) ( ) Not Requested Reserved Rights: NASA reserves the royalty-free right to practice the licensed invention throughout the world for all governmental purposes. Patent Prosecution: NASA would continue to prosecute and maintain the above referenced patents (US only). Ownership: NASA currently owns the above referenced patents, or patents pending, and can warrant same.

C. Licensee Information Licensee’s Full Name (corporate or individual): Address (including country): Phone: Fax: E-Mail: Parent Company Name and Address (if applicable): Place of Incorporation: Employer Identification Number (EIN): Is Applicant a U.S. citizen ( ) yes ( ) no (if individual application)?

License Application from | Page 2 of 4 D. Authorized Representative Authorized Representative’s Full Name: Address (including country): Phone: Fax: E-Mail:

E. Business Description Business Description: Number of Employees: Products/Services previously commercialized:

F. Source How applicant learned about the technology:

G. Small Business Status Small business under 37 FR§404.3(c), ( ) yes ( ) no which is generally defined as an independently owned and operated business with less than 500 employees?

H. Previous Federal Licenses Licenses previously granted to the applicant for any federally owned inventions:

I. Invention in Practice Describe (to applicant’s best knowledge) extent to which invention is being practiced by private industry, government, or both, and extent to which the invention is commercially available.

License Application from | Page 3 of 4 J. Proposed Royalties (Details Included in Income Pro Forma Spreadsheet) Proposed Up-Front License Fee: Proposed Royalty Rate Structure: Proposed Annual Minimum Royalty Payments: Proposed Royalty-Base Product and/or Process:

K. Other Information Any other information the application believes will support a determination to grant the requested license to the applicant.

Company understands that the above is the initial basis for an offer to license the NASA technology.

Signature:______Date:______

Title:

Return to: Sammy Nabors Manager, Technology Commercialization and Licensing Technology Transfer Office

Mailing Address: NASA Marshall Space Flight Center Building 4610 / Room 5410 Mail Stop ST22 / Sammy Nabors Huntsville, AL 35812

Phone: (256) 544-5226 Fax: (256) 544-4810 Email: [email protected]

Note: This information may be emailed to NASA with an electronic signature of the license applicant.

License Application from | Page 4 of 4