Partnership Licensing Form

Licensing Interest Form

"*" indicates required fields

Which SRNL technology are you interested in licensing?*

What is the U.S. Patent Number, software name, or copyright reference number?

Your entity's public information

What is your entity’s legal name?*

Type of organization*

E.g., public (provide stock exchange symbol), private, private VC-backed, non-profit, etc.

Size*

E.g., government qualified small business, medium or large corporation

Website Address*

U.S. state of incorporation (if not a U.S. entity, enter country):

If your entity is a subsidiary of or is controlled or influenced by any non-U.S. person or entity through investment, ownership, or management, specify the following:

• Controlling or influencing entity name
• Country in which controlling or influencing entity is incorporated
• Relationship with non-U.S. person or entity (parent, affiliate, partner, investor, etc.).

Have you previously licensed technology from a U.S. Department of Energy national laboratory?*

Yes

Your Contact Information

Name*

First Last

Title*

Email*

Phone*

By submitting this form, you understand SRNL can only provide unique work and cannot compete with the private sector.*

Yes

By submitting this form you understand that: SRNL is a U.S. government-owned facility; the information provided is subject to verification and/or background checks by the U.S. government; incomplete submissions may not be processed.*

Yes

The Savannah River National Laboratory (SRNL) is the U.S. Department of Energy’s (DOE) applied research and development laboratory at the Savannah River Site (SRS). With its wide spectrum of expertise in areas such as homeland security, hydrogen technology, materials, sensors, and environmental science, SRNL’s cutting-edge technology delivers high dividends to its customers. The management and operating contractor for SRNL is Battelle Savannah River Alliance, LLC. BSRA is responsible for transferring its technologies to the private sector so that these technologies may have the collateral benefit of enhancing U.S. economic competitiveness.*

Acknowledge