Create a simple WP Template Q&A Form

Hi, Need programmer to help build a WP template for people to do DISC Personality Program. This project should be a easy one. Here is what the template suppose to do: 1) Let user key in particulars first before starting the profile test 2) Pop up 28 questions (one by one) and let user answer each question and finish by submitting the answers. 3) Email notification to user that test is completed and he/she will be notified soon for test results (content should be editable). Here is a sample: [login to view URL] Note: 1) I do not want all questions to be presented at once 2) I am ok with the graphics used (i.e Green Thumbs up = Bold text & Red Thumbs down = strike off) 3) I do not want the results to be displayed immediately I will provide the 1) text for the 28 questions As this is a straightforward project, I am not expecting to pay more than $50. Furthermore, the delivery should be done within a week. Thank you