This is what the form looks like in App Inventor.
This is what it looks like in an Android app with the App Inventor jars dropped into the app.
The app has a start page with a button that displays the above form.
It also has AdMob!!!
It took about two hours to get things built. I had to build the App Inventor jar, find new jar files that the jar needed and set the permissions in the manifest. It is still something I do by hand, but I am getting closer to being able to release the tools!