Go to Homepage Indicates required field Name Required clear Phone Required Age Required clear Gender Identity Required clear Do you identify with a minority group? If so, which one? Required clear Are you a U.S. Citizen or a legal U.S. resident? Required Yes If no, what is your country of citizenship? Other… Enter other… clear How did you learn about the Google/Patent Diversity Project? Required What type of help do you think you need? For example, general patent advice, filing a patent application, responding to an office action, etc. * Required Email Required Address Required Employer(s) Required Please provide name and contact information including address, phone number and email. Employment Required Full-time Part-time Other… Enter other… clear Position(s) Required Are you the owner of the company? Required Yes No Other… Enter other… clear If yes Required How many business partners do you have? How many people work at the company? What is the company’s annual gross income? Please note that verifying documentation is required. Other… Enter other… clear Number of people in household including you Required clear What is your annual gross income? If you are identified as a dependent on another’s tax return or others are identified as dependents on your tax return, please provide the annual household income. Required clear Please note that verifying documentation is required. Current Innovation Field Required clear Please provide a general description of your invention. Required Do NOT provide any specific details about your invention. Start Date of Work Required Completion date of work Required Do you have any documents or notes describing your invention? Required Yes No Other… Enter other… clear Do you have a prototype/working version? Required Yes No Other… Enter other… clear Did you look at other products or information that relate to your invention? How did you find the products or information? When? Did you do a prior art search? Did you find products or information that look or function like your invention? Required clear Did anyone else work with you on the invention or provide you with financial assistance relating to your work on the invention? Required Yes No Other… Enter other… clear If yes, please describe Required Did you do this work as part of your employment? Required Yes No Other… Enter other… clear If yes, please describe Required Have you discussed or shown your invention to anyone else? Required Yes No Other… Enter other… clear If yes, please describe Required Are there any person(s) or company(ies) with whom you have entered into a confidentiality agreement, non-competition agreement, employment agreement, or other agreement that relates to your invention? Required Yes No Other… Enter other… clear If yes, please describe Required Have you spoken with any attorneys regarding your invention? Required Yes No Other… Enter other… clear If yes, please describe Required Please provide name and contact information including address, phone number, and email. Have you paid the attorney, or have you gotten pro bono services? Did you file a patent application? What is your prior knowledge regarding patents? Required Have you ever filed a patent application on a different invention? Required Yes No Other… Enter other… clear If yes, what type of invention is it? Required Please provide the filing date, named inventor(s), and country of filing. Did you work with an attorney? If yes, please provide name and contact information including address, phone number, and email. Did you pay the attorney for the work on that application, or did you get pro bono legal services? How about the filing fees? Who paid for those? Did you get a patent? Why or why not? Please describe any other ways in which you’ve gained familiarity about the patent process and the requirements of patenting. Required Signature Required Sign here I, APPLICANT, agree as follows: Completion of this application does not entitle me to legal representation. By completing this application, there is no formation of an attorney-client relationship with Cardozo Law School, Yeshiva University, or any persons associated with Cardozo or Yeshiva that I am speaking with in connection with this application. Additionally, none of the above will provide any financial assistance to me. If the Project does match me with a pro bono attorney, it does not mean that any preliminary determination of patentability of my invention has been made. Further, it is in the sole discretion of the attorney I am matched with to determine whether to represent me, and if so, the terms of that representation. I understand that even if I receive pro bono representation from an attorney I am matched with, I will still be responsible to pay the fees set forth in the USPTO fee schedule. https://www.uspto.gov/learning-and-resources/fees-and-payment/uspto-fee-schedule. The Project is entitled to use certain information from this application including gender, age, ethnicity, field and general nature of invention, country of birth, state of residence, prior patent understanding and/or prior filing, and whether I have already filed a patent application related to the current invention. Use of this information will be on an anonymous basis for date collection and analysis. I must promptly notify you if there is an increase in my annual household income. APPLICANT certifies that the information contained in this application is complete and accurate to the best of Applicant’s knowledge and that Applicant understands and agrees to the above terms. Leave this field blank clear
