Copyright Disclosure Form

**Please Note: Because of funding limitations currently, we are not accepting new applications. Please check back at the end of June 2014. Thank you for your understanding**


This form is for those wishing to protect some form of original work, or copyright. Copyright is a form of intellectual property law, that protects original works of authorship including literary, dramatic, musical, and artistic works, such as poetry, novels, movies, songs, computer software, and architecture. Copyright does not protect facts, ideas, systems, or methods of operation, although it may protect the way these things are expressed.

For more information on what can be copyrighted, please visit the US Copyright office page here>>

Please fill out this form as completely as you can and remember to press the “Send” button when finished.

    Your Name:

    Your Address:


    Your Phone # :

    Your Email Address:

    Alternate Contact Name:

    Alternate Contact Address:


    Alternate Contact Phone #:

    Alternate Contact Email:

    Tribal Affiliation:

    What is the best method for contacting you?

    What is the title of your work?

    Do you wish to be listed as the owner of this mark?

    If you selected No, please provide the name and address of all other owners (use a separate sheet if necessary):


    Are you the sole author of this work?:

    If you selected No, please provide the name, address, and contribution of all authors of this work (use a separate sheet if necessary):


    How did he/she help create the work?

    Are the author(s) your employees that created the work as part of their employment?

    If the author(s) are not your employees did you hire them for the specific purpose of creating this work?

    Do you have a written agreement regarding the ownership of this work?

    If you selected Yes, please attach a copy of that agreement:

    Describe your work. Attach pictures, videos, diagrams, documents or other items that may help to describe your work:

    What date was your work completed?

    Has your work been publicly displayed or sent to other people?

    If you selected yes, describe the people or business you sent the work to and why.

    As a requirement for assistance, NAIPEC usually requires that the invention benefit a tribe, tribal business, or the Native American community. Describe how the protection or sale of your work will benefit a tribe or the Native American community.