Confidentiality Agreement Form (CDA)

1. BU Contact Information:

BU Principal Investigator (PI) Name*

BU PI Department*

BU PI Email*

BU PI Phone*

BU PI Fax

BU PI Lab Location*

Room, street, and ZIP code

(optional) Check here if to specify an alternate BU contact besides the PI.

Alternate BU Contact Name and Email

2. External Party who will be participating in exchange of information:

External Party Institution Name:*

External Party PI:*

External Party PI Phone*

External Party PI Email*

External Party Provider Administrative Contact (if known):

(e.g., person negotiating the contract on behalf of the external party)

External Party Provider Administrative Contact Phone

External Party Provider Administrative Contact Email

External Party Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

3a. Is this confidentiality agreement related to the license or option for your existing intellectual property?*

3b. Will this confidentiality agreement be used for any of the following?*

(check all that apply)

Sponsored Research
Research Collaboration
Fee-for-service activity
Other / not sure
None of the above

4. Which party will disclose confidential and proprietary information?*

Inbound - External party will disclose confidential information to BU
Outbound - BU will disclose confidential information to External party
Mutual - Both parties will disclose confidential information to the other.

Please describe the nature of the information you are going to RECEIVE.*

Please describe the nature of the information you are going to PROVIDE.*

Please describe the nature of the information that the parties are going to EXCHANGE.*

5. What is the anticipated time period during which this exchange of Confidential Information will take place?*

6. Will the Purpose for the CDA require the transfer of BU materials?*

Yes
No

7. Please specify other comments or concerns that we should be aware of while negotiating this CDA, e.g. sponsors, grants, etc.

8. Does the sponsor indicate that any of the following restrictions or limitations will be applied to your activities under this agreement? Please check all that apply.*

Not Applicable
Prior approval for dissemination/publications
Restrictions on access or participation by foreign nationals
Export control restrictions [International Traffic Arms Regulations (ITAR), Export Administration Regulations (EAR), Nuclear Regulations]

I certify that I have answered these questions truthfully to the best of my knowledge, have undertaken any investigation necessary to do so, and will abide by the terms and conditions of the CDA and agree to:

A. Protect the External Party’s Confidential Information (if any) by maintaining appropriate security measures at your BU office/laboratory (e.g., locked file cabinets, restricted access to only BU employees or others under your supervision who have a need to know for the Purpose and have agreed to the terms of the CDA, etc.); and

B. Identify, mark and if applicable, send a written summary of any BU Confidential Information sent to the External Party in accordance with the terms of the CDA.

Signature*

You may sign this form using S-signature format .e.g. /John Q. Doe/

Upload any relevant documentation (e.g., Word version of draft agreement from external party, IRB approval letter, etc.) here:

Drop files here or

Accepted file types: pdf, doc, docx, xls, xlsx, Max. file size: 100 MB.

Date*

Name

This field is for validation purposes and should be left unchanged.

Confidentiality Agreement Form (CDA)

Complete Form

I certify that I have answered these questions truthfully to the best of my knowledge, have undertaken any investigation necessary to do so, and will abide by the terms and conditions of the CDA and agree to:

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