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Media Request Form
Education Resource Center
Archdiocese of Dubuque
1229 Mt. Loretta Ave.
Dubuque, IA 52003
(800)876-3546 ext. 214 or (563)556-2580 ext. 214
Fax: (563)556-5464
Email:
dbqcmed1@dbqarch.org
www.DBQArch.org/ERC
www.Pinterest.com/DBQArch
Your contact person will receive an email confirmation of your order once it has been processed.
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Email
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Institution Name
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Institution City
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Institution Contact Person Name
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Borrower Name (if different than above):
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Borrower Phone:
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Please enter the date you plan to use the media.
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The ERC staff will search top picks for you. Please tell us what you need: topic, age level, media types, etc.
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You may also order specific resources by title and/or catalog number. Please enter the information below.
Resource #1: Catalog Number, Title
Example: 19062, Catholicism: A Journey to the Heart of the Faith
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Resource #2: Catalog Number, Title
Example: 19062, Catholicism: A Journey to the Heart of the Faith
Your answer
Resource #3: Catalog Number, Title
Example: 19062, Catholicism: A Journey to the Heart of the Faith
Your answer
Resource #4: Catalog Number, Title
Example: 19062, Catholicism: A Journey to the Heart of the Faith
Your answer
Resource #5: Catalog Number, Title
Example: 19062, Catholicism: A Journey to the Heart of the Faith
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