Web Form - PHP

We need a simple web form built. The data from the web form is an application for a service we offer and must be stored in a DB. The form data is attached in a word doc. The only fields not in the document that needs to also go into the DB is -an "Affliate" field which will be hidden in the form source. -an Application status field will be "new", "needs more info", "submitted", "rejected", "accepted" -date created -date submitted Several of the form fields must be encrypted in the DB. A simple hash encryption should be fine. There must also be an admin interface which requires a login (a single login hard coded in the PHP will be fine for now). The admin interface should show a list of all applications. This list will show the following details: -Applicant Name -Application Status -Date Created The Admin should be able to click on any of the applications to view and edit ALL of the fields and change its status. The Admin should also be able to delete an application.