Drop Down Boxes and Text Entry Fields

Hi there,

I am wondering whether anyone can offer any help please, I am trying to create a slide in a project as part of a Feedback/Survey style piece of content. On this slide I wanted to include two drop down boxes with options to select from (e.g course type and trainer name - see attached image) and then this information to be able to be filled in two text entry fields below (so the data can be recorded of the course type and trainer and displayed in reporting). This works in Articulate and in the project but when published to the LMS and trying to pull results through it only features the first text entry field (e.g only displaying the course type 'accounting' and not the trainer name). Please excuse the rough layout of the slide, just trying to work it out at present! :)

Is it possible to create this on one slide and to be able to draw from the second text entry field or will I need to have the drop down boxes on separate slides?

Any help would be greatly appreciated :-)

Thanks,
Olivia