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If you find anything in error, please contact Stephanie Rodgers (

Application Information

Application Name:

Application Owner:

Application Technical Contact:

Application Support Model: 

Application Administration Model:

Application Description:

Application Marketplace ID/Link:

ServiceNow RequestDistribution Status & DateInternal Review Status & DateePHI IndicatorTarget User Base
 should we have them complete a ServiceNow form?    

Review Status: complete or incomplete

Internal Distribution Request DateOffice of Technology Transfer ReviewLegal Counsel Review (if applicable)Compliance & Regulatory ReviewIT Security Review

Architecture Review (if applicable)


Approval Artifacts

Approval artifacts may be located here: (Box folder)

  1. Completed IP Disclosure.
  2. Commercial Evaluation Report.
  3. Legal Counsel Review.
  4. Compliance and Regulatory Review.
  5. IT Security Review.
  6. Architecture Review.
  7. Distribution Review Checklist.


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