IP Innovation Clinic Pre-Intake Questionnaire

Thank you for your interest in the services of the IP Innovation Clinic.

Please complete this form to be considered for intake with the IP Innovation Clinic. Following your submission of this form, a member of the IP Innovation Clinic will contact you for additional information.

Please note: The completion of this questionnaire does not guarantee that you will be accepted as a client with the IP Innovation Clinic. Until such time that you have been approved by our supervising lawyer and executed an engagement agreement with the IP Innovation Clinic, you have no formal relationship with us and are responsible for your own affairs.

At this pre-intake stage, there is no need and value in you providing us with confidential documents and extraneous information. To protect your confidential information do not disclose any confidential details about your invention, service, or product. At this time, we only require general information to assess if we can assist you with your matters.

Following receipt of this information, an IP Innovation Clinic representative will contact you and schedule a time to discuss your inquiry further.

Please note: IP Innovation Clinic Staff and Fellows do not provide legal advice. IP Innovation Clinic Fellows work under the supervision of practicing lawyers to provide IP information to our clients. The Innovation Clinic operates in accordance with the relevant rules and regulations of the Law Society of Ontario.

1General Information > 2Background Information (1) > 3Background Information (2) > 4About Your Invention (General) > 5About Your Business (General) > 6Review Your Entry
I have read, understand and agree to the statement and conditions above.

I have read, understand and agree to the statement and conditions above. Yes
Name Name First Last
1) Are you a York University community member (eg. faculty, researcher, student, alumni and/or staff)?

1) Are you a York University community member (eg. faculty, researcher, student, alumni and/or staff)? Yes No

Please note: You do not need to be a YorkU community member to receive IP Innovation Clinic services.
If Yes, please specify:
If Other, please explain:
If No, please specify:

For clarity:

SME is any business which is constituted, established, or organized under the laws of the federal Parliament or any provincial or territorial Legislature; is controlled, directly or indirectly, by a Canadian; has fewer than 500 full-time equivalent employees; and is operating in Canada.

Entrepreneur is any person with at least 6 months of full-time experience in the last 12 months as a business owner with an active role who owns at least one third of the business, or a senior manager responsible for strategic decision-making and day to day operations.

Non-YorkU Researcher is a member of a college of applied arts and technology or a university that receives regular and ongoing operating funds from the government for the purposes of post-secondary education, an academic hospital, or research institute for conducting research, including faculty members; adjunct professors; visiting professors or researchers; undergraduate students; graduate students; postdoctoral fellows; research associates; technical staff; and any other person involved directly or indirectly in research or supporting the commercialization of the research.
If Other, please explain:
2) Company Name (if applicable)
3) Company (or venture) Location
4) Incorporation or Business Registration Number (if applicable)
If Incorporated or a Registered Business, place of Incorporation or Business Registration
5) Position with Company (if applicable)
6) Number of Employees
7) Email
8) Web Site (if applicable)
9) Phone 9) Phone - ### - ### ####
10) Address 10) Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
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