Application form for wordpress website

Hello, My request is rather simple. I need to create an online form for a website that runs on a wordpress backend. The form is to have the same field as the attached pdf document. it's an application form for a scholarship and the information has to be routed via email or any other way to the application reviewers. What I need: - a solution, whether it's a wordpress plugin, or your own proprietary solution (remember, it's running on a wordpress backend) - your estimate of time it will take to implement this. If you are selected you will also get the little project of implementing the whole thing (there will be two forms, one in english and one in french). This is rather urgent. message me if you have any questions.