Patent Pro Bono » Form Test 1

First Name*

Middle Initial

Last Name*

Address*

Street AddressAddress Line 2CityStateZIP Code

Applicants must be from Missouri, Nebraska, Oklahoma, Kansas, or Arkansas

Email*

Daytime Phone Number*

1)

Are you a U.S. citizen or legal U.S. resident?*

Your gender

Your ethnicity

Your age range

What countries are you a citizen of if not just the U.S.?

What country are you living in?*

What languages do you speak fluently?*

What is your annual household income?*

Please include employment income, alimony, child support, and government assistance

How many people are in your household?*

2)

Do you have now, or have had, the assistance of counsel with respect to a patent application?*

Have you disclosed or published the invention?*

Have you assigned your rights in your invention to anyone or any company?*

Are there any time lines associated with any office actions to be aware of?*

How many patent applications have you filed?*

3)

Do you currently have a provisional or non-provisional application filed with the USPTO?*

If yes, and the application has been published what is the application number?

If no, have you completed the pro bono training program on the USPTO pro bono page and received a certificate of completion?*

If no, and a provisional or non-provisional has not been filed, you are required to complete the course at this link. http://www.uspto.gov/video/cbt/certpck/index.htm

4)

Have you completed a prior art search?*

If no, do you plan to do a prior art search?

5)

Write a brief abstract of your invention.*

In no less than 3 to 4 sentences, describe the general technical area of your invention and the general improvement it provides. Do NOT include any confidential or novel features, and do NOT provide any specific details about your invention. Include provisional patent number *if applicable*

How did you hear about our program

Payment Reference Number:*

Reference number is provided with your emailed receipt when payment has been processed.

Form Test 1 – Request Form

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