\documentclass{article}
\begin{document}
\begin{center}
\bfseries\large Certificate\\
\Large Olympic Spring Games\\
Walterville 1992\\[1ex]

\normalsize
\typein{Sport} \\[1ex]
\mdseries
\typein[\unit]{Unit}

\begin{tabular}{lllrl}
\bfseries Gold   & \typein{Gold - Name:}   & \typein{Gold - Country:} 
   & \typein{Gold - Value`:}   & \unit \\
\bfseries Silver & \typein{Silver - Name:} & \typein{Silver - Country:}
   & \typein{Silber - Value:} & \unit \\
\bfseries Bronze & \typein{Bronze - Name:} & \typein{Bronze - Country:}
   & \typein{Bronze - Value:} & \unit
\end{tabular}
\end{center}
\end{document}

