AI USE DISCLOSURE STATEMENT — TEMPLATE

Free template from Freelance Ops Kit — https://freelanceopskit.com/templates/ai-use-disclosure-statement-template/
A blank outline, not a filled-in example and not legal advice. Replace each bracketed instruction with your own content, then delete the brackets. Your funder's own instructions always take precedence over this template.

[Organization name] | [Funder name] | [Application title] | [Date]

## AI Use in This Application
[Select one: "No generative AI tools were used to produce the content of this application." OR continue with the sections below.]

## Tools Used
[Tool name and version or model, if known] | [Provider]

## Tasks the Tool Was Used For
[List only tasks you actually did with it, e.g., brainstorming an outline, summarizing your own source material, editing for clarity. Do not list tasks you did not do.]

## Where It Appears in the Application
[Which sections, or "throughout." Match the funder's required location, e.g., a form field, the project description, or a footnote.]

## Human Review
[Who reviewed the AI-assisted text, what they checked (facts, figures, citations, organization details), and when.]

## Information Provided to the Tool
[State plainly what you did and did not enter, for example whether any confidential or personal data was entered into a tool.]

## Contact
[Name, title, email]

## Record-Keeping Log (optional)

| Date | Section | Tool | What it did | Who checked | Funder-required note? |
|---|---|---|---|---|---|
|  |  |  |  |  |  |
|  |  |  |  |  |  |
|  |  |  |  |  |  |