diff --git a/html-templates/questionnaire.tpl b/html-templates/questionnaire.tpl
new file mode 100644
index 00000000..5c29f7f0
--- /dev/null
+++ b/html-templates/questionnaire.tpl
@@ -0,0 +1,116 @@
+{extends "designs/site.tpl"}
+
+{block "title"}{_ 'Onboarding Questionnaire'} — {$dwoo.parent}{/block}
+
+{block "content"}
+    <div class="container">
+        <div class="row">
+            <div class="col-8">
+                <div class="page-header">
+                    <h1>Onboarding Questionnaire</h1>
+                </div>
+
+                {contentBlock "questionnaire-introduction"}
+
+                {*if !$Project->isValid}
+                <div class="error well">
+                    <strong>{_ "There were problems with your entry:"}</strong>
+                    <ul class="errors">
+                    {foreach item=error key=field from=$Project->validationErrors}
+                        <li>{$error}</li>
+                    {/foreach}
+                    </ul>
+                </div>
+                {/if*}
+
+                <form method="POST">
+
+                    <fieldset class="form-group">
+                        <legend>I am a&hellip;</legend>
+
+                        <div class="row">
+                            <div class="offset-sm-1 col-sm-6">
+                                {foreach from=$roles key=key item=title}
+                                    <div class="form-check">
+                                        <input class="form-check-input" type="checkbox" name="roles[]" id="role__{$key|escape}" value="{$key|escape}">
+                                        <label class="form-check-label" for="role__{$key|escape}">{$title|escape}</label>
+                                    </div>
+                                {/foreach}
+                                <div class="form-row align-items-center">
+                                    <label class="sr-only" for="role__other">Other:</label>
+                                    <input type="text" class="form-control" id="role__other" placeholder="Other&hellip;">
+                                </div>
+                            </div>
+                        </div>
+                    </fieldset>
+
+                    <fieldset class="form-group">
+                        <legend>Technology Experience</legend>
+
+                        <div class="row">
+                            <div class="offset-sm-4 col-sm-2 text-center">
+                                No experience / Want to learn
+                            </div>
+                            <div class="col-sm-2 text-center">
+                                Beginner
+                            </div>
+                            <div class="col-sm-2 text-center">
+                                Intermediate
+                            </div>
+                            <div class="col-sm-2 text-center">
+                                Advanced
+                            </div>
+                        </div>
+
+                        {foreach from=$technologies key=key item=title}
+                            <div class="row">
+                                <div class="offset-sm-1 col-sm-3">
+                                    {$title|escape}
+                                </div>
+                                <div class="col-sm-2 text-center">
+                                    <input type="checkbox" name="skills[{$key|escape}]" value="1">
+                                </div>
+                                <div class="col-sm-2 text-center">
+                                    <input type="checkbox" name="skills[{$key|escape}]" value="2">
+                                </div>
+                                <div class="col-sm-2 text-center">
+                                    <input type="checkbox" name="skills[{$key|escape}]" value="3">
+                                </div>
+                                <div class="col-sm-2 text-center">
+                                    <input type="checkbox" name="skills[{$key|escape}]" value="4">
+                                </div>
+                            </div>
+                        {/foreach}
+                    </fieldset>
+
+                    <fieldset class="form-group">
+                        <legend>I would describe my tech experience as</legend>
+
+                        <div class="row">
+                            <div class="offset-sm-1 col-sm-6">
+                                <div class="form-check">
+                                    <input class="form-check-input" type="radio" name="experience" id="experience__1" value="1">
+                                    <label class="form-check-label" for="experience__1">Just Starting/Student</label>
+                                </div>
+                                <div class="form-check">
+                                    <input class="form-check-input" type="radio" name="experience" id="experience__2" value="2">
+                                    <label class="form-check-label" for="experience__2">Mid-level</label>
+                                </div>
+                                <div class="form-check">
+                                    <input class="form-check-input" type="radio" name="experience" id="experience__3" value="3">
+                                    <label class="form-check-label" for="experience__3">Senior</label>
+                                </div>
+                                <div class="form-check">
+                                    <input class="form-check-input" type="radio" name="experience" id="experience__4" value="4">
+                                    <label class="form-check-label" for="experience__4">Lead</label>
+                                </div>
+                            </div>
+                        </div>
+                    </fieldset>
+
+                    <button type="submit" class="btn btn-primary">{if $Project->isPhantom}{_ 'Create Project'}{else}{_ 'Save Changes'}{/if}</button>
+                </form>
+            </div>
+        </div>
+    </div>
+{/block}
diff --git a/site-root/questionnaire.php b/site-root/questionnaire.php
new file mode 100644
index 00000000..8184e0e0
--- /dev/null
+++ b/site-root/questionnaire.php
@@ -0,0 +1,35 @@
+<?php
+
+$roles = [
+    'frontend' => 'Front-end Developer',
+    'backend' => 'Back-end Developer',
+    'fullstack' => 'Full Stack Engineer',
+    'data-engineer' => 'Data Engineer',
+    'data-analyst' => 'Data Scientist/Analyst',
+    'devops' => 'DevOps Engineer',
+    'product-manager' => 'Product Manager',
+    'project-manager' => 'Project Manager',
+    'ux' => 'UX/UI',
+    'graphic-designer' => 'Graphic Designer',
+];
+
+$technologies = [
+    'react' => 'React',
+    'django' => 'Django',
+    'vue' => 'Vue',
+    'php' => 'PHP',
+    'python' => 'Python',
+    'r' => 'R',
+    'git' => 'Git',
+    'change-management' => 'Change Management',
+    'pm' => 'Project Management Frameworks/Tools',
+    'docker' => 'Docker',
+    'javascript' => 'Javascript',
+    'ux' => 'UX/UI',
+    'wordpress' => 'WordPress',
+];
+
+RequestHandler::respond('questionnaire', [
+    'roles' => $roles,
+    'technologies' => $technologies
+]);