Form Plugin Needed

I need to put a form on a blog that I am working on. I have a couple plugins that deal with forms but none of them quite meet all of my needs.

I need a plugin that allows input of a persons name, the date, and a message. However, I also need a check list that contains all of the categories in the blog so that the appropriate category can be checked and the form will be posted in that category (just like if you were to post something through the admin panel).

I have yet to find a plugin that fits this description. If anyone knows of a plugin that will do all of this, please let me know!

Thank you,

Rachael