Creating website question & data collection.

I'm working on a project, that if successful would be a website built on Wordpress. Easy enough. I could do that myself. There could be an additional design component. Again, that's the nice to have.

The project is to help design a layout that would allow for someone to finish this sentence, "My giving is _______." The answers to that blank are then collected in a survey tool or database. I'd like for people to be able to see all of the answers that other people have contributed when they move to the next page.

Ideally, the set up is as sparse as the Google search page. As they enter deeper into the sight, I'd then be able to build out additional pages.

I've looked into all survey tools: Survey Monkey, Poll Daddy, Poll Snacks and none of them see to give me the right formatting options.

The optional nice to have is a nice design behind the "My giving is ______" perhaps with post-it notes that have possible answers to the question.

I've attached a brief sketch.

A few more details:

I have a Wordpress Template and can build/host the actual site myself. What I need help with is two-fold:

1. the data entry design and collection portion
2. the graphic design

I hope that is more clear. Please let me know if you have questions.

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