CDA/NDA Request Form "*" indicates required fields The purpose of this form is for a UTSI PI to request a confidentiality agreement (CDA) to facilitate technical discussions and the sharing of confidential information between UTSI and an outside entity. The Office of Proposals and Contracts will use the information provided to begin the review and negotiation process. No research or work should be conducted under a CDA. If you need to share materials or samples in addition to confidential information or perform evaluations or research with the outside entity, please contact our office directly or include detailed information herein regarding the additional requests. DIRECTIONS: This form should be completed by the UTSI PI requesting the CDA.UTSI ParticipantLead Principal Investigator:*Other UT personnel name/email/campus/departmentOUTSIDE ENTITY INFORMATIONEntity Name:Entity Technical Contact Name/Email:Entity Legal Contact Name/Email:CONFIDENTIAL INFORMATION TO BE DISCLOSEDProvide a description of the confidential information being disclosed.Does the information being disclosed include UT confidential information? Yes (must complete #3 and #4 below) No (proceed to next Section) Was the information developed from an internally- or externally funded UTSI research project? (explanation required): Internal External Is the information subject to any third-party rights or reporting obligations resulting from any ofthe following (select all that apply – explanation(s) required): Developed under externally sponsored research project (funded or unfunded) UTRF Invention Disclosure Other: None Detailed Description:DESCRIPTION OF THE PURPOSE AND USE OF CONFIDENTIAL DISCLOSUREProvide a detailed description of the purpose of this CDA, and the permitted uses of the information, e.g.discussions only, proposal development, etc.COMPLIANCE(select all that apply – detailed description(s) required):Conflict of Interest: Yes No Unsure Export Controlled Information: Yes No Unsure Detailed Description:EXTERNAL PARTIES/COLLABORATORSWill you need to provide any of the OUTSIDE ENTITY’s confidential information to any outside sponsors,collaborators, subcontractors, or other non-UT employees, including unpaid UT students? Yes (provide additional information regarding them and their involvement) No Detailed Description:By submitting this form, you agree that all information is correct. The form will be submitted directly to UTSI Office of Proposals and Contracts.* Agree CommentsThis field is for validation purposes and should be left unchanged.