diff --git a/awx/ui_next/src/components/FormField/TextAndCheckboxField.jsx b/awx/ui_next/src/components/FormField/TextAndCheckboxField.jsx
new file mode 100644
index 0000000000..5cbf70acf9
--- /dev/null
+++ b/awx/ui_next/src/components/FormField/TextAndCheckboxField.jsx
@@ -0,0 +1,85 @@
+import React, { useState } from 'react';
+import { useField } from 'formik';
+
+import { Checkbox, FormGroup, TextInput } from '@patternfly/react-core';
+import styled from 'styled-components';
+import Popover from '../Popover';
+
+const InputWrapper = styled.span`
+  && {
+    display: flex;
+  }
+`;
+function TextAndCheckboxField({
+  id,
+  label,
+  helperText,
+  isRequired,
+  isValid,
+  tooltip,
+  name,
+  type,
+  rows,
+  ...rest
+}) {
+  const [field, meta] = useField({ name });
+  const [fields, setFields] = useState(field.value.split('\n'));
+  let array = field.value.split('\n');
+
+  return (
+    <FormGroup
+      fieldId={id}
+      helperText={helperText}
+      helperTextInvalid={meta.error}
+      isRequired={isRequired}
+      validated={isValid ? 'default' : 'error'}
+      label={label}
+      labelIcon={<Popover content={tooltip} />}
+    >
+      {fields
+        .map((v, i) => (
+          <InputWrapper>
+            <Checkbox />
+            <TextInput
+              id={id}
+              isRequired={isRequired}
+              validated={isValid ? 'default' : 'error'}
+              value={v}
+              type={type}
+              onChange={value => {
+                if (value === '') {
+                  setFields(fields.filter((f, index) => i !== index));
+                } else {
+                  setFields(
+                    fields.map((f, index) => {
+                      if (i === index) {
+                        return value;
+                      }
+                      return f;
+                    })
+                  );
+                }
+              }}
+            />
+          </InputWrapper>
+        ))
+        .concat(
+          <InputWrapper>
+            <Checkbox />
+            <TextInput
+              id={id}
+              isRequired={isRequired}
+              validated={isValid ? 'default' : 'error'}
+              value=""
+              type={type}
+              onChange={(value, event) => {
+                setFields([...fields, value]);
+              }}
+            />
+          </InputWrapper>
+        )}
+    </FormGroup>
+  );
+}
+
+export default TextAndCheckboxField;
diff --git a/awx/ui_next/src/components/FormField/index.js b/awx/ui_next/src/components/FormField/index.js
index bd1e65ef92..63e127bcf1 100644
--- a/awx/ui_next/src/components/FormField/index.js
+++ b/awx/ui_next/src/components/FormField/index.js
@@ -4,3 +4,4 @@ export { default as PasswordField } from './PasswordField';
 export { default as PasswordInput } from './PasswordInput';
 export { default as FormSubmitError } from './FormSubmitError';
 export { default as ArrayTextField } from './ArrayTextField';
+export { default as TextAndCheckboxField } from './TextAndCheckboxField';
diff --git a/awx/ui_next/src/screens/Template/Survey/SurveyQuestionForm.jsx b/awx/ui_next/src/screens/Template/Survey/SurveyQuestionForm.jsx
index 93f47aba77..4469ffa532 100644
--- a/awx/ui_next/src/screens/Template/Survey/SurveyQuestionForm.jsx
+++ b/awx/ui_next/src/screens/Template/Survey/SurveyQuestionForm.jsx
@@ -10,7 +10,9 @@ import FormField, {
   CheckboxField,
   PasswordField,
   FormSubmitError,
+  TextAndCheckboxField,
 } from '../../../components/FormField';
+
 import AnsibleSelect from '../../../components/AnsibleSelect';
 import Popover from '../../../components/Popover';
 import {
@@ -75,7 +77,10 @@ function SurveyQuestionForm({
   const defaultIsNotAvailable = choices => {
     return defaultValue => {
       let errorMessage;
-      const found = [...defaultValue].every(dA => choices.indexOf(dA) > -1);
+      const found = [...defaultValue].every(dA => {
+        console.log(dA, '\n', choices);
+        return choices.indexOf(dA) > -1;
+      });
 
       if (!found) {
         errorMessage = t`Default choice must be answered from the choices listed.`;
@@ -203,7 +208,7 @@ function SurveyQuestionForm({
             )}
             {['multiplechoice', 'multiselect'].includes(formik.values.type) && (
               <>
-                <FormField
+                <TextAndCheckboxField
                   id="question-options"
                   name="choices"
                   type="textarea"