AI assistance acknowledgement preparation form

Working notes for /guides/how-to-cite-ai. Complete this for your own assessment; this is not an approved institutional declaration or a certificate of compliance. A log does not grant permission to use AI. Do not copy the constructed example entries as your own history.

1. Identify the assessment
Course / task:
Relevant instructor or subject coordinator:
Instructions location and date checked:
What assistance is permitted for this specific task?
What is prohibited or still unclear?
Question to ask before continuing if permission is unclear:

2. Summarize what actually happened
Tools used (include a URL if useful):
Model / version, only if actually known; otherwise write “not recorded”:
Dates and task stages:
Purpose and scope of each use:
What output influenced the work, including ideas, structure, code, images or wording?
What was retained, changed or rejected?
What checks did I actually perform? Name the passages, sources or comparisons checked:
What remains unverified or unresolved?

3. Inspect the records before describing availability
Where are the actual prompts and outputs stored?
Can I reopen them, and do they cover all uses or only some?
Missing conversations, dates or versions:
What records can I actually provide if requested?
Do not state that a full record is available unless that is true. Describe partial or missing records honestly. A CSV summary is not automatically a complete prompt/output transcript.

4. Prepare the required acknowledgement and citations
Required institutional / course form or wording, if any:
Required placement, submission method and referencing style:
Which uses need acknowledgement under these instructions?
Which retained outputs also need citations or references under the required style?
Write a factual account of tools, purpose, scope and how outputs were used. Use the course's required format. Do not assume a declaration replaces a required citation, or a citation replaces a required declaration.

My draft acknowledgement (write only claims I can support):


5. Review before submission
Does my account cover the assistance I actually used?
Does it distinguish checks I completed from checks I still need to do?
Have I avoided guessing model versions or claiming missing records exist?
Remaining question for the instructor / coordinator:

This original AI Essay preparation form is informed by the university guidance linked on the guide. Requirements differ between institutions, courses and assessments; check the rules that apply to your work.