Healthy Active Arkansas Rethink Your Drink: Choose Water

Funding Application

The goal of Healthy Active Arkansas is to increase the percentage of adults, adolescents and children who are at a healthy weight. Rethink Your Drink: Choose Water! is Healthy Active Arkansas' campaign to encourage students and school staff to drink more water during the day. Providing access to drinking water throughout the school day gives students a healthy alternative to sugary beverages like soda, energy, sports, and juice drinks. Drinking plenty of water can help combat obesity, increase energy levels and may improve students' cognitive functions. Further, if fluoridated, drinking water also plays an important role in preventing cavities and maintaining oral health. Through a partnership with Delta Dental, Healthy Active Arkansas has committed $41,000 to REPLACE existing drinking fountains with combination water bottle filling station-drinking fountain units at a select number of schools as part of the Rethink Your Drink campaign. Healthy Active Arkansas has developed a Rethink Your Drink toolkit to aid schools and worksites in promoting increased water consumption. To access the toolkit, visit: https://healthyactive.org/wp-content/uploads/2017/11/Rethink-Your-Drink-Toolkit.pdf Your school could be one of those selected to receive the following:

TIMELINE

One or more new water fountain/filling stations Access to Healthy Active Arkansas' Rethink Your Drink toolkit to educate students and

staff on the benefits of choosing water over sugar-sweetened beverages

Grant application deadline: 4:00 p.m. on February 28, 2019

Grant recipients announced: middle of April 2019

Station installed by August 5, 2019

Final grant report due: middle of January 2020

ELIGIBILITY REQUIREMENTS

All Arkansas K-12 schools are eligible to apply. Schools will provide all information requested in the application prior to the

deadline.

GRANT RECIPIENT REQUIREMENTS

Sign a grant agreement prior to receiving the water fountain/bottle fillingstation(s).

Station should be installed and operational by August 5, 2019. School is responsible for costs associated with installation. If assistance is needed

with installation expense, see page 6 of application. Submit a grant report no later than 30 days upon completion of project

(Healthy Active Arkansas will supply reporting forms). Work with Healthy Active Arkansas to promote grant partnership through media

opportunities, organization materials, social media, etc. Acknowledge Healthy Active Arkansas and Delta Dental in educational materials and

promotional events.

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Healthy Active Arkansas Rethink Your Drink: Choose Water

Funding Application

GRANT REQUEST REQUIREMENTS

• Only one application per school will be reviewed. If more than one is received, theapplication with the earliest submission date will be considered.

• Must include a signed copy of the application. An electronic or typed signature is notacceptable.

• Questions about the program or application should be directed to SSBR@achi.net

GRANT SUBMISSION GUIDELINES

• Grant application deadline: 4:00 p.m. on Thursday, February 28, 2019.• The original application and supporting documents may be submitted by email or regular

mail. Applications may be emailed to Jennifer Wessel at SSBR@achi.net or mailed to:

Arkansas Center for Health Improvement Attention: Jennifer Wessel

1401 West Capitol, Suite 300 Little Rock, AR 72201

GRANT SUBMISSION CHECKLIST

_____ Completed application form with required signatures of both applicant and school principal_____ Photos of the water fountain(s) to be replaced_____ Copy of the school's water policy, if one is currently in place_____ Cost estimate for fountain installation, if requesting financial assistance to have station installed

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Healthy Active Arkansas Rethink Your Drink: Choose Water

Funding Application

CONTACT INFORMATION

Name of School

School District

School Mailing Address

School Physical Address

City

State

Zip Code

County

School Phone Number

School Principal Name

School Principal Email

Applicant Name

Applicant Phone Number

Applicant Email

Name of Superintendent

Superintendent Email

School or District Tax ID

Is the building principal aware that you are applying for this grant?

Is the superintendent aware that you are applying for this grant?

Arkansas

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DEMOGRAPHIC INFORMATION 1. How many students are enrolled in the school?

For more information contact your school administrative office or visit http://myschoolinfo.arkansas.gov/Plus/Schools

2. How many teachers and support staff does your school have?

3. What grades are served by your school?

4. What percentage of your students participate in the free and reduced lunch program?For more information contact your school administrative office or visit http://myschoolinfo.arkansas.gov/Plus/Schools

5. Percentage of student population assessed as overweight and obese fromthe school’s BMI data.For more information visit http://bmi.achi.net/Pages/SchoolPersonnel/BMIProgram.aspx

OVERVIEW

6. How do you think this opportunity would benefit the students and staff at your school?

FACILITIES INFORMATION

7. Do you currently have any water fountains installed at your school?If yes, how many?

8. Ideally, how many fountains would you like to have replaced?

9. Approximately how old is/are the fountain(s) you would like to have replaced?

10. Where is the water fountain(s) you want to have replaced (i.e. hallway, cafeteria, gymnasium)? Listall locations.

11. Is the plumbing to the existing water fountains functioning properly?

12. Do your current water fountains have a functioning electrical source?

13. Is the source of the school's water fluoridated?

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PROJECT INFORMATION

14. How do students at your school currently access drinking water during the school day?

15. Are students allowed to carry water bottles with them during the school day?

16. Is there a written policy that allows students to use their water bottles during the school day?

If yes, does the school commit to continued implementation of the water policy? Please provide acopy of the policy with your application.

17. Do community members have access to the water fountain(s) to be replaced?

If yes, is access allowed outside of school hours?

18. Do the students in your school currently receive oral health education?

19. What types of health initiatives or programs, including oral health education and/or screenings, doesyour school currently offer? (Check all that apply)

School Garden

Utilization of GoNoodle

Farm to School

Fresh Fruit and Vegetable Program

Student Wellness Advocacy Group (SWAG) or Project Prevent Youth Coalition (PPYC) Dental Clinic

Joint Use Agreement

Intramural Sports Programs for Students

School Based Health Center

Provision 2 or Community Eligibility

Recess Before Lunch

Dental Sealant Program

Breakfast Enhancement Programs (Breakfast in the Classroom, Breakfast After the Bell, etc.)

Other Programs (provide information below)

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20. Would you be willing to distribute oral health and nutrition/physical activity education materials tostudents, parents, and staff?

PROMOTION

21. Does your school commit to implementing an oral health education program?

If yes, please provide a list of activities or programs that will be conducted and the target dates.

22. Would you be agreeable to inviting the news media into your school to showcase the RethinkYour Drink: Choose Water! campaign and allow interview students and staff?

23. Does your school/district have a communications or public relations department or staff person?

If yes, please provide contact information.

FINANCIAL BURDEN

Only if your district is requesting financial assistance to cover installation expenses, should a water filling station be awarded, please provide a justification of the need below. A copy of a written estimate from a local professional must be submitted with your application.

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Attach photo of the water fountain you would like to have replaced. If you are requesting replacement for more than one, attach photos of each and label the photos by the order you would like them replaced.

Does your school commit to completing and submitting all of the following evaluation components?

1. Report delivery date and installation date of water fountain/bottle filling station.

2. Complete installation of water fountain/bottle filling station by August 5, 2019.

3. Report monthly usage of the water fountain/bottle filling station by recording numbers provided from theunit counter that is a part of the filling station.

4. Provide a summary of promotional events and education programs provided to students and staffthrough the use of the Rethink Your Drink toolkit.

5. Provide feedback on the grant application process.

6. If a written water policy is not in place, the school will partner with the school or district wellnesscommittee to develop and present a written water policy to the local school board.

Select one option below.

I certify to the best of my knowledge that all information in this grant application is correct and I have read and agree to the terms and conditions as outlined.

School Principal Signature Date

Applicant Signature (if not Principal)

Title Date

The following factors may affect the funding decision: Healthy Active Arkansas (HAA) reserves the right to fund applications out of rank order depending on the demographic and geographic distribution of the highest scoring applications. HAA may fund out of rank order to achieve geographic and/or economic diversity.

7For electronic submissions, you will need to scan and submit this page as an additional attachment titled "signature page."

PRODUCT SPECIFICATIONSElkay ezH2O® Bottle Filling Station with Single ADA Cooler, Filtered 8

GPH Stainless. Chilling Capacity of 8.0 GPH (gallons per hour) of 50 F

drinking water, based on 80 F inlet water and 90 F ambient, per ASHRAE 18 testing. Features shall include Hands Free, Visual Filter Monitor, Filtered, Green Ticker™, Laminar Flow, Antimicrobial, Real Drain. Furnished with Flexi-Guard Safety Bubbler. Electronic Bottle Filler Sensor With Electronic Front And Side Bubbler Pushbar activation. Product shall be Wall Mount (On Wall), for Indoor applications, serving 1 station(s). Unit shall be certified to UL 399 and CAN/CSA C22.2 No. 120. Unit shall be lead-free design which is certified to NSF/ANSI 61 & 372 (lead free) and meets Federal and State low-lead requirements.

Special Features: Hands Free, Visual Filter Monitor, Filtered, Green Ticker™, Laminar Flow, Antimicrobial, Real Drain

Finish: Stainless Steel

Power: 115V/60Hz

Bubbler Style: Flexi-Guard Safety Bubbler

Activation by: Electronic Bottle Filler Sensor With Electronic Front And Side Bubbler Pushbar

Mounting Type: Wall Mount (On Wall)

Chilling Option*: 8.0 GPH

Full Load Amps 6

Rated Watts: 370

Dimensions (L x W x H): 18-3/8" x 19" x 39-1/16"

Approx. Shipping Weight: 85 lbs.

Installation Location: Indoor

No. of Stations Served: 1

*Based on 80° F inlet water & 90° F ambient air temp for 50° F chilleddrinking water.

Special Note: *Coming soon: The Elkay ezH2O you know and love is getting a fresh look, as shown here. In stock models may have prior logo design.

Visual Filter Monitor: LED Filter Status Indicator for when filterchange is necessary.

Filter is certified to NSF 42 and 53 for lead, particulate,chlorine, taste and odor reduction. 3,000 gal. capacity.

Green Ticker: Informs user of number of 20 oz. plastic waterbottles saved from waste.

Laminar flow provides clean fill with minimal splash.

Silver Ion Antimicrobial protection on key plasticcomponents to inhibit the growth of mold and mildew.

Real Drain System eliminates standing water.

AMERICAN PRIDE. A LIFETIME TRADITION. Like your family, the Elkay family has values and traditions that endure. For almost a century, Elkay has been a family-owned and operated company, providing thousands of jobs that support our families and communities.

Included with Product: Water Cooler (LZS8WSS), Bottle Filler (LZWSR), Filter

Ships in multiple boxes.

PRODUCT COMPLIANCE

ADA & ICC A117.1

Buy American Act

CAN/CSA C22.2 No. 120

GreenSpec®

NSF/ANSI 42, 53, 61, & 372 (lead free)

UL 399

Complies with ADA & ICC A117.1 accessibility requirements when installed according to the requirements outlined in these standards. Installation may require additional components and/or construction features to be fully compliant. Consult the local Authority Having Jurisdiction if necessary.

Installation Instructions (PDF)

5 Year Limited Warranty on the refrigeration system of the unit. Electrical components and water system are warranted for 12 months from date of installation. Warranty pertains to drinking water applications only. Non-drinking water applications are not covered under warranty.

Warranty (PDF)

OPTIONAL ACCESSORIES 51300C - WaterSentry Plus Replacement Filter (Bottle Fillers)

LKAPREZL - Elkay Cane Apron for EZ Gray

MLP100 - Accessory - In Wall Carrier (Single) for single EZ, LZ, EMABF, LMABF, VRC, LVRC models

98568C - WaterSentry Filter Mounting Cover (Stainless Steel)

PART:________________________________QTY: _____________

PROJECT:______________________________________________

CONTACT:______________________________________________

DATE:__________________________________________________

NOTES:_________________________________________________

APPROVAL:_____________________________________________

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COOLING SYSTEM

Compressor: Hermetically-sealed, reciprocating type,single phase. Sealed-in lifetime lubrication.

Condenser: Fan cooled, copper tube with aluminumfins. Fan motor is permanently lubricated.

Cooling Unit: Combination tube-tank type. Continuouscopper tubing with is fully insulated with EPS foam thatmeets UL requirements for self-extinguishing material.

Refrigerant Control: Refrigerant R-134a is controlled byaccurately calibrated capillary tube.

Temperature Control: Easily accessible enclosedadjustable thermostat is factory preset. Requires noadjustment other than for altitude requirements.

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