MyMine

First screen would be a list of buttons:

• feedback: ask for just two things + submit button ** a dumb text ** optional 5-star happiness rating
• problem report: several radio/check boxes + text + submit button ** sections of the app: issues/projects/roadmaps/wiki/servers/synchronization ** frequency: all the time/sometimes/erratic ** severity: critical/annoying/I can live with it ** text notes
• translation issue: language picker + text + submit ** dumb text ** language
• other: ** dumb text ** optional 5-star happiness rating

Has to be

• 3 separate screens
• very clear indication that there are only 3 steps and that it is quick
• clear UI and large buttons to ease the process

To be thought: how to design this for 7" and 10" tablets.