Non-Disclosure Agreement Request Form
Please complete and submit to Office of Technology Development
Faculty Name:
Your answer
Department:
Your answer
Department Chair:
Your answer
Company Name:
Your answer
Company Address:
Your answer
Company Technical Contact Name:
Your answer
Company Technical Contact Email:
Your answer
Will you be disclosing proprietary/confidential information?
Will the Other Party be disclosing proprietary/confidential information?
Provide a short description or summary of the proprietary/confidential information you will be sharing with the other Party.
Your answer
Are there other University faculty, staff, or students that will be in the discussion(s)?
If yes, please list their names and indicate if any are students.
Your answer
Are the students paid employees?
Is the NDA related to a Sponsored Research Agreement?
If yes, please provide name of sponsor/project.
Your answer
Are you disclosing export controlled information?
Are you receiving export controlled information?
Estimate the start date (i.e. date of first meeting/planned interaction with proprietary information exchange)
MM
/
DD
/
YYYY
Note: If there are any materials or samples that will be shared or transferred, a Material Transfer Agreement (MTA) will be needed.
Please go to OTD http://research.umbc.edu/documents-forms-and-agreements/ and complete a request form. Thank you!
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