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Are you applying as an individual or on behalf of a business organization? (Required)
Individual
Business
Business Organization Name (if any):
Name of Individual or Primary Contact Person (Required):
Your Email Address (Required):
Your Phone Number (Required):
Your Street Address:
Your City:
Your State:
Your Zip Code:
State of Incorporation (if Business):
Names of All Owners (if Business):
How did you hear about the IP Law Clinic? (Required):
Are you able to otherwise afford outside legal representation for the services that you are seeking from the Clinic using available sources of funding (e.g. personal incomes, organizational revenue, investor contributions, etc.)?
Yes
No
Do you or your business organization have any affiliation with Washington University? (Required)
Yes
No
If yes, what is the affiliation?
Have you or your business organization ever worked with any of Washington University’s legal clinics?
Yes
No
If yes, which one?
Which service(s) are you seeking assistance with? (Check all that apply) (Required)
General Intellectual Property Consultation
Patent Prior Art Searching and Patentability Opinion
Patent Application Drafting and Filing
Patent Office Action Response Drafting and Filing
Patent Infringement Issues
Patent Other
Trademark Registerability Searching and Registerability Opinion
Trademark Application Drafting and Filing
Trademark Infringement Issues
Trademark Other
Copyright Registration Filing
Copyright Infringement Issues
Copyright Other
Name, Image and Likeness (NIL) Consultation
Other (not listed above)
For each item above, please explain in detail your prospective IP Law Clinic project(s). (Required):
For example, what invention(s) or technology have you potentially invented; what brand name or logo do you wish to register a trademark for and what are the goods and services associated with the brand or logo; what type of work are you interested in registering a copyright for? It is imperative that you provide as much detail as possible as this information is critical to our consideration of your matter. If possible, please provide a link to an online file sharing service such as Dropbox (or similar) to include descriptions, drawings, photos, files, or other information that is relevant to your prospective project(s).
Race or Ethnicity (Optional; for Internal Statistical Purposes Only):
Gender (Optional; for Internal Statistical Purposes Only):
Age (Optional; for Internal Statistical Purposes Only):
25 and under
26-35
36-45
46-55
56-65
66+
SUBMITTING THIS APPLICATION TO THE CLINIC DOES NOT MAKE ANY PERSON OR ORGANIZATION A CLIENT OF THE CLINIC. THEREFORE, NO ATTORNEY-CLIENT RELATIONSHIP PRESENTLY EXISTS BETWEEN YOU OR YOUR ORGANIZATION AND THE IP LAW CLINIC. HOWEVER, WE WILL TREAT THIS APPLICATION AND ALL INFORMATION SUBMITTED HEREWITH AS CONFIDENTIAL IN ACCORDANCE WITH THE RULES OF PROFESSIONAL ETHICS.
I hereby declare that the information submitted in this form is true, correct, and complete. (Required)
Agree
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