Commercialization Report

Annual Bi-Annual

COMPANY NAME:

CURRENT DATE:

FOR PERIOD BEGINNING:

AND ENDING:

TECH TITLE AND U# (if several, use oldest)

CONTACT PERSON:

PHONE:

EMAIL:

1. Commercialization Efforts

Attach all requested documentation and attach additonal pages as necessary. For all requirements include efforts of all Sublicensees. If not applicable, please so indicate by N/A.

Estimated number of jobs created as a result of this Licensed Product/Licensed Method:

In the designated reporting period, your company or any Sublicensee of the above-referenced technology had 500 or more employees. (Thhis information is required to determine and report large or small entity status in the United States.)

2. Product Development

Attach all requested documentation and attach additional pages as necessary. For all requirements include efforts of all Sublicensees. If not applicable, please so indicate by N/A

Please attach any additional information:

A.Provide the commercial name of any FDA-approved products, incorporating, using or that are Licensed Products/Licensed Methods that have first reached the market during the designated reporting period. (This information is necessary for federal funding reporting requirements)

Pharmaceutical

N/A

LICENSED PRODUCT (NAME):

ESTIMATED DATE OF FIRST SALE:

FDA APPROVAL STAGE

CONTACT PERSON:

ESTIMATED START TIME:

ESTIMATED END TIME:

ESTIMATED BUDGET:

PRECLINICAL

NDA

PHASE I

PHASE II

PHASE III

ANIMAL STUDIES

MFG./PRODUCTION FACILITY

Medical Devices (PMA or 510(k))

N/A

LICENSED PRODUCTT (NAME):

ESTIMATED DATE OF FIRST SALE:

CLASS TYPE:

COMPLETION TYPE:

FDA APPROVAL STAGE

ESTIMATED START TIME

ESTIMATED END TIME

ESTIMATED BUDGET

PMA

501(k)

IDE

HDE

PRECLINICAL

PHASE I

PHASE II

PHASE III

MFG./PRODUCTION FACILITY

Software

N/A

LICENSED PRODUCT (NAME):

ESTIMATED DATE OF FIRST SALE:

FDA APPROVAL STAGE

CONTACT PERSON:

ESTIMATED START TIME:

ESTIMATED END TIME:

ESTIMATED BUDGET:

ALPHA VERSION

BETA VERSION

COMMERCIAL VERSION

3. Intellectual Property

Please provide type of intellectual property protection covering or related to the identified licensed product

4. Marketing Activities

A. Provide an update covering Licensee's projected marketing, manufacturing and operations


5. Additional efforts including, but not limited to, Due Dilligence or Milestones specific to licensee's Agreement.