University of Kansas

START-UP COMPANY CHECKLIST/QUESTIONNAIRE

 This Start-up Company Checklist/Questionnaire is intended to help KU researchers identify key
issues in the decision to form a start-up company based on KU research.
 The document Creating A Company gives additional general information, answers to frequently
asked questions and links to a variety of resources that may help you in your decision to form a
company.

 The Licensing Process for Start-up Companies

In order to license KU intellectual property for commercial use, your start-up company’s business plan
must be reviewed and approved by the KU Vice Provost for Research and Graduate Studies.
 To request a review, complete this form, schedule a meeting with the Executive Director of the KU
Center for Technology Commercialization, bring a draft or completed business plan. All key
personnel of the proposed company should attend the meeting.
 If the business plan is approved, negotiation of a license agreement will follow. (See (website link)
for more information about licensing KU technology)

 Licensing Terms and Issues

 The following are some of the terms that will be negotiated with the company in the License
Agreement with the University.
a. University royalty position
b. University equity position
c. Payment of continuing patent fees (including fees already expended by KU)
d. Milestone events
e. Milestone fees

 The following are some of the issues that must be included in the License Agreement with the
University.
a. Indemnification of University by Licensee/Company
b. Company product liability/insurance coverage
c. Company diligence in getting the technology to the public (commercialization)
d. Reservation of rights for the University to practice the invention for academic and research
purposes
e. If federal funding is involved, reservation of rights for the federal government

 Managing conflicts of interest

 Start-up companies that involve KU employees frequently create relationships that pose potential
conflicts of interest. Employees considering creating a company based on KU technology are
encouraged to disclose the prospective interest and meet with Research Integrity personnel as early
as possible so that an individualized plan can be developed and company-KU relationships can be
managed with respect to all applicable policies, regulations and laws.
 For further information about conflict of interest reporting and management:
a. Consult the Conflict of Interest web page http://www.rcr.ku.edu/coi/ or
b. Contact the Compliance Coordinator, Research Integrity, 785-864-4148 or sumac@ku.edu .

Technology Transfer at KU
To start the licensing process, return the completed form to:
James Baxendale, MS, MBA
Executive Director, KU Center for Technology Commercialization
KUMC campus
Wescoe Pavilion, MS 1039
Tel: 785-864-7783 Fax:785-864-5272
Email: jbaxendale@ku.edu http://www.ctc.ku.edu

Technology Transfer & Intellectual Property page 1 of 5

University of Kansas

START-UP COMPANY CHECKLIST/QUESTIONNAIRE For office use:

Rec’ by:
Date:
Primary contact for this worksheet
Name: Phone: e-mail:
Campus mail address:  Lawrence  Medical Center

The Technology
1. What technology or technologies developed at KU is the company interested in licensing?
Title 
Technology disclosure ID(s)  Date(s) disclosed (month/year)
Brief description 

IP Protection (check any that apply)  Patent pending  Patent awarded  Copyright  Copyright registered
Will development of the technology require human clinical trials?  Yes  No
Current stage of development 

Continuing Research
2. What is the current plan for ongoing research activities at KU that will relate to the company? For instance,
will the technology or related projects continue to be the subject of research at KU?
(type response here)

The Company
3. Description: What is the purpose of the proposed company? How will the technology will be used or
commercialized by the company?
(type response here)

4. Organizational Structure
Name of company (legal or proposed):
Has company been legally formed?  Yes  No Date (or anticipated date) of formation 
State of Incorporation:
Type of company:
 Sole Proprietorship  Corporation (Inc.)  Limited Liability Corporation (LLC)
 not yet determined  not for profit corporation (501c3)  other:________________________
Legal Business Address Laboratory or other address
Address 1
Address 2
City/state/zip
Phone fax Phone fax
e-mail e-mail
web Laboratory or other address (if applicable) web Laboratory or other address (if applicable)

Technology Transfer & Intellectual Property page 2 of 5

University of Kansas

Company Personnel and Key Players

5. Company owners/principals/officers. Please complete as much as possible for all owners and any
current principals or officers not already listed. Either Company Role or Company Ownership % may be “none.”
Company roles include positions such as President, Vice President, General Manager, CEO, COO, CTO, etc.
Name (owners, principals and/or officers only) KU employment Company ownership Is this individual a
spouse or household
member of a KU
Address Inventorship Company Role(s) owner?
1 Type name here KU employee?  yes  no Ownership %  yes  no
Type address here Inventor?  yes  no Role(s):
2 KU employee?  yes  no Ownership %  yes  no
Inventor?  yes  no Role(s):
3 KU employee?  yes  no Ownership %  yes  no
Inventor?  yes  no Role(s):
4 KU employee?  yes  no Ownership %  yes  no
Inventor?  yes  no Role(s):
5 KU employee?  yes  no Ownership %  yes  no
Inventor?  yes  no Role(s):

6. Inventor involvement in the company. Please identify any inventors who are not listed above and the
involvement of each, if any, in the company. Examples of roles in the company: employee or consultant.
Inventor Name Role in the company?
 no  yes 
 no  yes 
 no  yes 
 no  yes 
 no  yes 

7. Advisory Boards Have the following been formed?

Board of Directors Yes, listed below* Not at this time Not applicable
Is this individual a
spouse or household
Name Occupation/employment Address member of a KU owner?
 yes  no
 yes  no
 yes  no
Scientific Advisory Board Yes, listed below* Not at this time Not applicable
Is this individual a
spouse or household
Name Occupation/employment Address member of a KU owner?
 yes  no
 yes  no
 yes  no

8. Professional Services Have the following services been secured?

Legal Counsel No Yes (name, firm, address)
Accountant No Yes (name, firm, address)

Technology Transfer & Intellectual Property page 3 of 5

University of Kansas

Capitalization and Development Resources

9. How is the company currently capitalized? What plans have been made to capitalize the company in the
future?
(type response here)

10. Economic development resources: Have you sought assistance from economic development
organizations? (check any that apply)
 ARMF  Angel Investors  KBA  KTEC  KTEC Technology Commercialization Fund
 SBIR  STTR  Venture Capital  Other___________________________
(comments)

11. Corporate partners : Have corporate partners been secured for research funding and/or investment?
No Yes, listed below
Name Type of Organization Address

Company Development

12. Market analysis: Have markets been identified for the technologies or services the company will offer?
Yes (description or comments)
No

13. Business Plan: Is a Business or Product Development Plan available?

Yes, a plan is attached (description or comments)
No

14. Product Development: Does the company plan to sponsor research at the University to develop the
technology?
Yes (description or comments)
No

15. Business Services: Other than business office space and equipment, what facilities or services will the
company require? Examples include laboratories, computer infrastructure and specialized instruments.
Type response here

Does the company anticipate that facilities or services will be outsourced through KU or other entities?
Yes (description or comments)
No

Technology Transfer & Intellectual Property page 4 of 5

University of Kansas

E. Conflict of Interest Management

17. Conflict of Interest report update: According to Board of Regents policy (LINK), current or prospective
financial interests or time commitments related to your research and educational activities must be reported on
an ad hoc basis via the conflict of interest reporting forms. Have you and your KU colleagues filed an ad hoc
conflict of interest report to disclose your financial interest and time commitments in the company?

Yes No (visit this site to start reports online https://www.research.ku.edu/apps/ra/coi/ )

18. Managing Conflicts of Interest: According to the policy on Managing Inventor Conflicts of Interest (LINK),
a faculty owner/inventor should not normally act as Principal Investigator (PI) for research on the licensed
technology which are sponsored by the company of ownership. If the company plans to sponsor research at
KU, has a colleague or supervisor without interest in the company been identified to assume the role of
Principal Investigator? (For more information about sponsoring research at KU, see LINK)

Yes (name of designate)

Not at this time (comment )

19. Employment of students and KU staff: The policy on Employment of Students in Faculty-owned
businesses (LINK), describes acceptable relationships and forms required for employing students. The KU
Faculty-Staff Handbook, section (LINK), describes guidelines and issues for employment of subordinates in an
outside interest.

Does the company currently employ or anticipate employing KU students?  Yes  No

Does the company currently employ or anticipate employing KU staff?  Yes  No

Signatures

Inventor: Date

Inventor: Date

Inventor: Date

James Baxendale Date

Executive Director, KU Center for Technology
Commercialization

For office use:  Copy sent to Research Integrity (date) _________

Technology Transfer & Intellectual Property page 5 of 5