Turn HTML Template into XLM Fill out form for Joomla Users)

- I need to have a form setup based on a HTML layout so logged in Joomla users will be able to fill out the form, submit it, and the HTML code is recieved by an admin, or if it's not TOO complicated, outputted as a joomla or K2 article. - This will include various text fields, drop down options and image uploads with set resolution (possible auto scale feature) - The end result should look something like this once published as an article: [login to view URL] --- This task is open to ideas, please see attachements for how I would like it to work.