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Section: 440-4 Exhibit E
Effective: 4/1/98
Supersedes:
Issuing Office: Real Estate Development (RED)

LICENSE AGREEMENT
DATA AND APPROVAL SHEET
(THE REGENTS AS LICENSOR)

INITIATING PARTY INFORMATION:

LICENSE INITIATOR:______________________________________________________

MAIL CODE: __________________EXTENSION: _________________ FAX:___________________

DEPARTMENT:__________________________________________________________

LICENSE AGREEMENT INFORMATION:

PURPOSE OF LICENSE:_______________________________________________________________

____________________________________________________________________________________

AMENDMENT # (00 indicates a New License)

LICENSEE:__________________________________________________________________________

DESCRIPTION OF UC PROPERTY:________________________________________________________

TERM OF LICENSE: _________________________ to _____________________________ ( ___________ months)

OPTION(S) TO EXTEND: YES/NO: HOW MANY? HOW LONG?___________

EXPENSES: $ ________________________ REVENUE: $ __________________ (incurred/realized per agreement)

APPROVALS:

________________________________________________________________________________________
License Initiator / Date

________________________________________________________________________________________
Department Chair / Date

________________________________________________________________________________________
Vice Chancellor/Dean/Provost / Date


Policy | Exhibit A | Exhibit B | Exhibit C | Exhibit D | Exhibit F

ALSO AVALIABLE IN ADOBE ACROBAT PDF FORMAT
Exhibit C.pdf | Exhibit D.pdf | Exhibit E.pdf | Exhibit F.pdf |