"I was hoping someone with better knowledge could write the html and PERL/CGI script below so that we could go over it tomorrow and figure out how to do it ourselves."

Uh huh, go over it yourselves eh? This actually looks exactly like home/course work. I suggest reading the following and working through the example code where appropriate:

• http://learn.perl.org
• http://perldoc.perl.org
• Ovid's CGI Course
• The Tutorials section of this site.