Application for Vanderbilt Innovation Ambassadors | Center for Technology Transfer & Commercialization

The Innovation Ambassadors Program is an institutional initiative to provide Vanderbilt researchers with improved, peer-delivered access to information and assistance related to innovation and entrepreneurship on campus. The Program achieves this goal by recruiting an ambassador from each department to act as a liaison between researchers and innovation programs across campus. Ambassadors receive instruction on a variety of commercialization, intellectual property, and entrepreneurship topics, as well as application of Vanderbilt policies and procedures, all designed to enable them to help others in their departments obtain quick guidance and access to all of their innovation and entrepreneurship needs.

Applicant Information

Full Name

Please provide your full name.

First Name *

Middle Name

Last Name *

Contact Information

Primary E-Mail *

Primary Phone Number *

Applicant Information

Please indicate the school and department which you are a student or staff / faculty member of.

Affiliation *

Primary School *

Other School

You've selected other as the primary school, please indicate the name of the primary school by which you are employed or assigned.

Other Primary School *

Departments of Blair School of Music *

Other Department

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Other Department *

Departments of Arts and Science *

Other Department

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Other Department *

Owen Graduate School of Management *

Other Department

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Other Department *

Departments of Peabody College *

Other Department

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Other Department *

Departments of School of Engineering *

Other Department

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Other Department *

Departments of School of Medicine *

Other Department

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Other Department *

Departments of School of Nursing *

Other Department

You've selected other as the department, please indicate the name of the department by which you are employed or primarily assigned.

Other Department *

Division of the Administrative Department *

Other Division Fieldset

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Other Division *

Department *

Divisions of the Department of Anesthesiology *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Division of the Department of Biomedical Informatics *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Division of the Department of Biostatistics *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Division of the Department of Cardiac Surgery *

Other Division Fieldset

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Other Division *

Division of the Department of Emergency Medicine *

Other Division Fieldset

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Other Division *

Division of the Department of Hearing and Speech Sciences *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Division of the Department of Medicine *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Division of the Department of Neurological Surgery *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Division of the Department of Neurology *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Division of the Department of Obstetrics and Gynecology *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Division of the Department of Ophthalmology and Visual Sciences *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Division of the Department of Oral and Maxillofacial Surgery *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Division of the Department of Orthopaedic Surgery and Rehabilitation *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Division of the Department of Otolaryngology *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Division of the Department of Pathology, Microbiology and Immunology *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Division of the Department of Pediatric Surgery *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Division of the Department of Pediatrics *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Division of the Department of Physical Medicine and Rehabilitation *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Division of the Department of Plastic Surgery *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Division of the Department of Psychiatry *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Division of the Department of Radiation Oncology *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Division of the Department of Radiology and Radiological Sciences *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Division of the Department of Surgery *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Division of the Department of Thoracic Surgery *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Division of the Department of Urologic Surgery *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Other Department

You've selected other as the primary department, please indicate the name of the primary department by which you are employed or assigned.

Other Department School *

Division of the Administrative Department *

Other Division Fieldset

You've selected other as the division, please indicate the name of the division by which you are employed or primarily assigned.

Other Division *

Please provide the name of the employer in which you are employed or assigned during this invention.

Employer Name *