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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