Licensing with EASE Application You must have JavaScript enabled to use this form. Indicates required field First Name Last Name Email Address 1. Has the invention been disclosed to Venture Partners at ²ÊÃñ±¦µä? Yes No 2. What is the reference number of the invention? Format is CUXXXXB 3. What is the primary market application of the invention? Physical Science and/or Engineering Bioscience Software 4. What is the legal name and address of the incorporated startup company? 5. Has an individual with relevant business experience joined the company as an executive or board member? Yes No 5.a. What is the name and role of that individual? 6. Have all university employees with roles at the startup both a) executed employment/consulting agreements with the company, where such agreements include the university’s standard third party employment/consulting addendum, and b) filed an updated Disclosures of External Professional Activity (DEPA) form? Yes No