Building a worksheet

Hello, I'm a storyline newbie and am a little stuck.  I've built about a dozen interactive modules, with varying degrees of success, but am really stuck on this one.  I'm trying to replicate this worksheet (see inserted image). 

As you can see I'm hoping to:

- have students input multiple responses

- provide feedback and/or grade

   (feedback for individual responses would be stellar, but even an overall correct/not correct would be great too)

I've tried several strategies, but really can't get a handle on it.

Any advice - including "give up" (jk) would be greatly appreciated.

Thanks,

Suzanne