Shortened ask form?

I would like to have a short question submission or ‘Ask’ form at the top of a separate page (not my questions page)
Here is what I currently have:
http://staging.nwcm.com/capitalyou/faq/
I would like to have no text editing options, just a plain text box, and to get rid of ‘title’, ‘category’, and ‘name’.
Is that possible and how do I do it?

Thank you