IP Clinic Intake Form

Please note:

Due to a high volume of requests, our current response time can take up to six months. If you require immediate assistance, we encourage you to contact your local bar association for a referral to an attorney.

Additionally, our services are limited to residents of Pennsylvania. If you live outside of Pennsylvania, please contact your local bar association.

Penn State Dickinson Law IP Clinic Intake Form

Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Are you currently located in the Commonwealth of Pennsylvania?*
- Yes
- No
Phone*
Alternate Phone
Email Address*
Is your annual household income below the current USPTO Micro Entity Status Gross Income Limit (i.e $216,109 as of March 2021)?*
- Yes
- No
I am seeking service as*
- Individual
- Business
Has a legal entity been formed?*
- Yes
- No
If a legal entity has been formed, what is the legal entity's name?
I am part of:*
- FastTrack Accelerator Program
- Summer Founders
- Penn State Smeal College of Business
- None of the above
Are you part of the Penn State or LaunchBox and Innovation Hub Network Community?*
- Yes
- No
Are you currently, or have you been a Client of any Penn State Dickinson Law IP Clinics or Programs?*
- Yes
- No
If you've been a client, which clinic or program were you a client at?
Have you received any funding for this matter?*
- Yes
- No
- n/a
Have you consulted any attorney(s) on this matter?*
- Yes
- No
Do you have any patent applications on file?*
- Yes
- No
Please identify your legal needs
- Patent
- Trademark
- Trade Secret
- Copyright
- General IP advice
Brief description of the nature of your business and legal needs.*
How did you learn about the Penn State Law IP Clinic? If you were referred to the IP Clinic, who referred you?*

123 S. Burrowes Street, 2nd Floor
State College, PA 16801

(814) 865-7134 (Option 1)

Invent Penn State is a Commonwealth-wide initiative to spur economic development, job creation and student career success.

This project was financed in part by a grant from the Commonwealth of Pennsylvania, Department of Community & Economic Development.

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