Clone a Simple Website for Educational Purposes

There is a website based on JavaScript that has a query page. The user types things like: Name: Fred Flintstone Document ID: 1234-56 Date: 12/23/2013 and the systems displays a page with results. We need to make a small copy, a prototype of that page. You have flexibility in the implementation, but it must be Linux-compatible. Having a very close look and feel to the original is essential. For the first version (this project), we can use simple text as data, and later we can have more data in a MySQL database. You must be prepared to deliver whatever material you have coded at any time, before the end of the project. The project has no deadline, I am very flexible in that respect, but I prefer not to hire coders who are working on a dozen projects or more. We never hire workers without Freelancer evaluations.