Dynamic Checkboxes on Interactive Report

I have an interactive report that currently lists a row of values:
Field1
Val1
Val2
Val3
I would like to place a text-field at the top of this interactive report with a submit button:
[textbox] [submit button]
Field 1
Val1
Val2
Va3
Then I would like to have checkboxes [] appear in each row:
[textbox] [submit button]
Field1 | Checkbox
Val1 | []
Val2 | []
Val3 | []
Then I would like to make it so that the user enters some text into the textbox and selects any number of the row checkboxes. Upon hitting submit, a procedure will run that accepts each Field1 value and inserts a record into a table containing 2 fields: the Field1 value and the textbox text.
So the following user input:
[Test text in the textbox.] [submit button]
Field1 | Checkbox
Val1 | []
Val2 | [x]
Va3 | [x]
After hitting the submit button, a procedure would be called that would insert 2 records into a table:
Field1 | Field2
Val2 | Test text in the textbox.
Val3 | Test text in the textbox.
Note that there is no entry for Val1 because its checkbox was not checked when the user pressed submit.
What can I do to make this happen? I appreciate any help you can offer.

Thanks for sharing
I am having exactly the same problem.
I have an interactive report with the following SQL.
select RSN_CD,
    DESC,
APEX_ITEM.CHECKBOX(1,RSN_CD) "Select"
from CAN_RSN
I've set the 'Select' column's type to 'Standard Report Column'.  But the checkbox does not appear on the report. 
Apex Version: 4.0.1.00.03
Thanks.

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