ProBoPat Application

Page 1

We would like to ask some questions about you. The information you provide will be kept entirely confidential and used only by Mi Casa and our program partners to serve you more effectively. Please answer all questions to the best of your knowledge.

If you have more than one last name, please enter them here.

Employer Information

Income Information

Please upload your 2022 Federal Income Tax Return

For verification of income and dependents, please provide a copy of your Income Tax Return Form 1040 for the most recent tax year.
USPTO Training Information

 Please go to and complete the training.

Completion of the training module is required of all inventors to have your application reviewed for acceptance into the ProBoPat Program.

For the next section of this application, Invention Information, please provide only a general description of your idea in your answers below. If you are accepted into the ProBoPat program, ProBoPat will attempt to pair you with a patent practitioner to whom you can then share the details of your invention.


(Limit 1)

NO INVENTION DETAILS PLEASE Good Example: My idea relates to an improved gripping mechanism for a pencil. Bad Example: My idea relates to a pencil grip that has criscross grooves intersecting at 30 degree angles over 40% of the gripping surfact.

Each co-inventor must submit an application, tax return, and Pro Bono Program Certificate of Completion.

Have you filed a provision or non-provisional patent application with the USPTO for this invention?

*Completing this form in no way obligates ProBoPat or Mi Casa to assist with a timely referral for your pending patent application. See Acknowledgements on next page.

ProBoPat Application Fee - $50.00

  • I understand that there is a $50 Application Fee to participate in the ProBoPat program
  • I understand that once I am notified of my acceptance into the ProBoPat program that I must pay the $50 fee to Mi Casa Resource Center to complete the application process.

Applicant Acknowledgments

By signing below, I understand and agree that:
a. The information provided in this form is true and complete to the best of my knowledge, and I understand that false or misleading information may result in delays in, or denial/termination of, referral assistance.

b. I will notify ProBoPat if the information on this form materially changes, for example if my contact information changes or my annual household income materially increases.

c. Neither ProBoPat, nor Mi Casa Resource Center, provides legal advice. I understand that I am not entering into an attorney-client relationship with ProBoPat or Mi Casa Resource Center, or any of their employees, steering committee members, volunteers, or board members. ProBoPat is only a referral service.

d. I will not provide any confidential information to ProBoPat, and except for the Income Information identified above, this form does not contain any information which I expect ProBoPat to keep confidential. I will only provide confidential information to a patent practitioner who agrees to represent me.

e. ProBoPat may deny anyone's application or remove an applicant from further participation, for any reason, in its sole discretion.

f. Patent matters can be very time sensitive. ProBoPat and Mi Casa Resource Center do not guarantee that a suitable patent practitioner will be found, nor do they guarantee that one will be found within a reasonable amount of time. I understand that I must independently seek counsel for any time sensitive matter, or any other matter for which I am uncomfortable using the ProBoPat referral system.

g. If my application is accepted and I am referred to a patent practitioner, the representation will in most cases be limited to a specific case and a specific amount of time or phase of patent prosecution.

h. ProBoPat does not currently offer referrals for assistance with trademark or copyright matters, or any non-patent prosecution matters.

i. I agree that the patent practitioner representing me can provide procedural status reports of non-confidential information as well as the filing date and serial number of any patent applications filed, to the ProBoPat program.

j. I understand that I am responsible for paying the government fees for a patent practitioner (For more information regarding the fees, see the ProBoPat FAQs.)

Please click Submit ProBoPat Application button to review and e-sign application.
Please note: acceptance of e-signature on ProBoPat application does NOT guarantee acceptance to ProBoPat program.

PTO 450 (Rev.4/20)

Approved for use through 06/30/2023. OMB 0651-0082

U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE

Under the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless it displays a valid OMB control number



Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB Control Number. Response to this information collection is voluntary; however, the data collected from this survey will be used to evaluate and publicize the Patent Pro Bono Program. Any comments on the amount of time you require to complete this survey and/or suggestions for reducing this burden, should be sent to the Chief Administrative Officer, United States Patent and Trademark Office P.O. Box 1450, Alexandria, VA 22313-1450

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