Need to create a Google Form using the fields marked in red in the attached PDF. For example, we started the first page of the PDF in the form URL below. Thank you.
https://docs.google.com/forms/d/e/1FAIpQLSeYSQRZBeb5YYPeVXGi7nyKFflFw5QUeBVZ26tWckMX-85VXw/viewform