Assignment AI statement — template

The per-assignment companion to the syllabus statement. Two pieces: (A) the level table that goes at the top of your assignment brief, and (B) the disclosure statement students paste at the end of their submission. A filled example from Case A is included.

(A) For the assignment brief: the stage/level table

AI use in this assignment

Each stage names its AI-use level (AI Assessment Scale v2.1 — icon and text everywhere in our materials):

Stage Due AI level

[Stage 1 — e.g. proposal] [week] 2 · AI Planning — AI may help you plan; the decision is yours

[Stage 2 — e.g. sources] [week] 1 · No AI — you find, open and read these yourself

[Stage 3 — e.g. draft] [week] 3 · AI Collaboration — AI feedback allowed; log it; critique it

[Stage 4 — e.g. final + defence] [week] 1 · No AI — the secure part that certifies your learning

Disclose AI use from stages 2–4 (anything above No AI) in the statement below. Honest disclosure at the stated level never costs you marks. Undisclosed use where No AI is set is an integrity matter.

No paid subscription is needed for any AI-permitted stage. If access or accommodations are an issue, contact us before the due date — alternatives are built in.

Stage	Due	AI level
[Stage 1 — e.g. proposal]	[week]	2 · AI Planning — AI may help you plan; the decision is yours
[Stage 2 — e.g. sources]	[week]	1 · No AI — you find, open and read these yourself
[Stage 3 — e.g. draft]	[week]	3 · AI Collaboration — AI feedback allowed; log it; critique it
[Stage 4 — e.g. final + defence]	[week]	1 · No AI — the secure part that certifies your learning

(B) For the student submission: the disclosure statement

AI-use statement (paste at the end of your submission; delete levels that don’t apply)

Level used per stage: [e.g., “Stage 1: AI Planning; Stage 3: AI Collaboration; Stages 2 and 4: No AI.”]

Tools: [e.g., “ChatGPT free tier; university-licensed assistant for grammar check”]

What I used it for: [one line per use: “brainstormed counter-arguments; feedback on paragraph clarity”]

What I kept, rejected, verified: [e.g., “accepted 2 of 5 suggestions; rewrote the rest myself; verified every source by opening it — AI suggested none”]

One thing I learned or would do differently: [one sentence]

Worked example (Case A essay, stage 3)

AI-use statement. For this essay I used ChatGPT (free tier) at AI Planning level: I asked it for possible counter-arguments to my thesis and listed two in my plan. For the draft I worked without AI (No AI). After the draft I used the university’s AI feedback tool at AI Collaboration level to check paragraph clarity; I rewrote two paragraphs in my own words where it suggested changes I disagreed with. I verified every source by opening and reading it — AI suggested none of them.

Facilitator notes

Keep the table to 3–5 stages; more becomes a compliance form, not guidance.
Grade the statement lightly (part of an AI-use-judgment criterion, like Case A’s criterion 4) — penalising disclosure teaches concealment.
If a student’s statement contradicts the work, ask questions first (the mini-defence), don’t open with the integrity process.