simpleforms

<form-designer>
    <title>Choose Chuck Norris API Category</title>
    <heading>Choose from the following: -
Please enter the desired category number inside the input field.
</heading>
<select label="Q4">
   <title>
     Please rate the following items, 1 means it's your most favorite and 
     3 means it's your least favorite.
   </title>
   <comment>Please select one for each selection</comment>
   <choice name='ch1' label="ch1">1</choice>
   <choice name='ch2' label="ch2">2</choice>
   <choice name='ch3' label="ch3">3</choice></select>          
<action name="submit" content='SUBMIT' icon='check' validates='true' ClosesDialog='true' ></action>
</form-designer>