Not sure why you put an image/screenshot in word so we have to download it, instead of just uploading it directly to the forum where we can show it immediately without having to open any other application, but I guess you have your reasons.
However, somehow is what you are showing totally different to what you write. where is the drop down list?
Anyway, your example that you are showing is a little bit more complicated, because you have one text boxes there. So filling in those text boxes and passing them on to the array question is not a problem. The problem is that with the simple solution you will have empty spaces showing, if not all text boxes in the first question are filled.
However, I think I remember that Tpartner posted a Javascript solution for this problem in the forum.