Input screen design that looks like a Cross tab

[Nancy]

I need to design an input/update screen for the following table:
Name Level Date1 Date2 Date3 Date4 RSVP
Jack L1 1/5/2005 1/7/2005 1/9/2005 2/4/2005 Y
Jack L2 3/3/2005 3/7/2005 3/9/2005 4/1/2005 Y
Jack L3 5/2/2005 5/5/2005 5/8/2005 6/1/2005 N
Mary L1 2/5/2005 2/7/2005 3/6/2005 3/8/2005 N
Sam R1 4/4/2005 4/6/2005 4/8/2005 5/1/2005 N
Sam R2 6/1/2005 6/4/2005 6/9/2005 7/3/2005 N
Sam R3 8/2/2005 8/8/2005 8/9/2005 9/3/2005 Y


This is what the screen needs to looks like:
Input screen for Sam:

Level R1 R2 R3

Date1 4/4/05 6/1/05 8/2/05
Date2 4/6/05 6/4/05 8/8/05
Date3 4/8/05 6/9/05 8/9/03
Date4
Date5
Date6
RSVP


It is ALMOST a Crossta, but not really. Any ideas oh How to do this ???

Thanks for any advice you can offer