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.
Email *
Institution Name *
Institution City *
Institution Contact Person Name *
Borrower Name (if different than above):
Borrower Phone: *
Please enter the date you plan to use the media. *
MM
/
DD
/
YYYY
The ERC staff will search top picks for you. Please tell us what you need: topic, age level, media types, etc.
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
Resource #2: Catalog Number, Title
Example: 19062, Catholicism: A Journey to the Heart of the Faith
Resource #3: Catalog Number, Title
Example: 19062, Catholicism: A Journey to the Heart of the Faith
Resource #4: Catalog Number, Title
Example: 19062, Catholicism: A Journey to the Heart of the Faith
Resource #5: Catalog Number, Title
Example: 19062, Catholicism: A Journey to the Heart of the Faith
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