Doc Code: MES.IHEB
Document Description: Certification of Micro Entity Status (Education Basis)

PTO/SB/15B (07-14)

CERTIFICATION OF MICRO ENTITY STATUS(INSTITUTION OF HIGHER EDUCATION BASIS)
Application Number or Control Number (if applicable):

Patent Number (if applicable):First Named Inventor:

Title of Invention:

CERTIFICATION ON THE BASIS OF EMPLOYMENT BY AN INSTITUTION OF HIGHER EDUCATION

The applicant hereby certifies the following—
The applicant qualifies as a small entity as defined in 37 CFR 1.27.
The applicant’s employer, from which the applicant obtains the majority of the applicant’s income, is aninstitution of higher education as defined in section 101(a) of the Higher Education Act of 1965 (20 U.S.C.
1001(a)).
SIGNATURE by an authorized party set forth in 37 CFR 1.33(b)Signature
Name
Date

Telephone

Registration No.

There is more than one inventor and I am one of the inventors who are jointly identified as the applicant. The required
additional certification form(s) signed by the other joint inventor(s) are included with this form.

CERTIFICATION ON THE BASIS OF ASSIGNMENT OR OBLIGATION TO ASSIGN TO AN INSTITUTION OF HIGHEREDUCATION

The applicant hereby certifies the following—
The applicant qualifies as a small entity as defined in 37 CFR 1.27.
The applicant has assigned, granted, conveyed, or is under an obligation by contract or law, to assign, grant, orconvey, a license or other ownership interest in the particular application to an institution of higher education as
defined in section 101(a) of the Higher Education Act of 1965 (20 U.S.C. 1001(a)).
SIGNATURE by an authorized party set forth in 37 CFR 1.33(b)Signature
Name
Date

Telephone

Registration No.

There is more than one inventor and I am one of the inventors who are jointly identified as the applicant. The required
additional certification form(s) signed by the other joint inventor(s) are included with this form.

NOTE: A signed copy of this “institution of higher education basis” micro entity certification form
(PTO/SB/15B) filed together with a signed copy of the “gross income basis” micro entity certification
form (PTO/SB/15A) will be taken to be a representation that any inventor or person applying for apatent as provided in 37 CFR 1.46 not qualifying on the “gross income basis” qualifies on the “institutionof higher education basis.”

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The information provided by you in this form will be subject to the following routine uses:
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The information on this form will be treated confidentially to the extent allowed under the Freedom ofInformation Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C 552a). Records from this system of records may
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