Inventor Request for Pro Bono Assistance
ATTENTION – READ FOLLOWING PARAGRAPHS BEFORE FILLING OUT APPLICATION

Thank you for your interest in the Patent Pro Bono Program. We are the administrators for the states of Missouri, Kansas, Arkansas, Oklahoma, and Nebraska only, if you do not reside in one of those states please send me an email and I can point you in the right direction.

In order to move to the next step in the program, applicants must pay an administrative fee. The fee is $50 for solo inventors, $100 for non-profits, and $150 for small businesses. Payments can be made at http://patentprobono.com/products-page/checkout/

Please be sure you have read the eligibility requirements here before submitting fee. http://patentprobono.com/eligibility/

Payment ensures an art search and patentability opinion on your invention. Patent Attorneys are not guaranteed but we will do our best to place each inventor with an attorney.

For more information please email Hayley at hjohnston@gatewayvms.org

All information provided on this form is confidential and will not be shared outside of the Patent Pro Bono Program. Thank you!
First Name *
Your answer
Last Name *
Your answer
Address *
Your answer
City *
Your answer
State *
If you do not see your state, please email hjohnston@gatewayvms.org
Zip Code *
Your answer
Email *
Your answer
Daytime Phone Number *
Your answer
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 US?
Your answer
What country are you living in? *
Your answer
What languages do you speak fluently? *
Your answer
What is your annual household income? *
Please include employment income, alimony, child support, and government assistance
Your answer
How many people are in your household? *
Your answer
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 timelines associated with any office actions to be aware of? If so, please explain. *
Your answer
How many patent applications have you filed? *
Your answer
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?
Your answer
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
Have you completed a prior art search? *
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*
Your answer
How did you hear about our program? *
Have you submitted your administrative fee? *
If so, please provide your payment reference number.
Reference number is provided with your emailed receipt when payment has been processed.
Your answer
I understand that by submitting this application that I have read all the information on the Patent Pro Bono website and acknowledge that placement with an attorney is not guaranteed. *
Type full name below.
Your answer
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