ContribSurvey is a flexible, self-hosted library with ability to create backend web apps for managing simple web-based surveys & feedback forms.
Its a free library where you can just download and install ContribSurvey on your own web server running CodeIgniter and from then on you then have complete control over your data and your application. You (or your web team) can integrate ContribSurvey into your own website or intranet seamlessly to ensure your surveys give a polished, professional impression to your site viewers.
SCREENSHOT http://d2qcctj8epnr7y.cloudfront.net/uploads/desc-surveyscreen.png