How can I achieve this field layout for a form?

Hi iwizzforms, 

Thanks for reaching out to Jotform Support. That field layout is possible by using the Input Table field. You can set the Input Table as Multi-type Columns for your requirement. Here's how you can do that:

1. Add the Input Table field to your form and click on its Gear icon.
2. Then go to the Fields tab.
3. Choose Multi-type Columns under Input Type.
4. Set the specific field type under Column Types.

Give it a try and let us know how it goes.