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The current Wikipedia:Upload screen, presents the user with:

{{Non-free use rationale
|Article=
|Description=
|Source=
|Portion=
|Low_resolution=
|Purpose=
|Replaceability=
|other_information=
}}
in the Summary field when a non-free use option is selected. However, when uploading a file from the Uploading a file from a website subpage, the user is presented with the:

{{Information
|Description=
|Source=
|Date=
|Location=
|Author=
|Permission=
|other_versions=
}}
template, regardless of the licensing option selected.

What I propose is that when a non-free use subpage or licensing option is selected by the user, the Summary box is replaced by a series of form fields that correspond to the Non-free media template. The user must enter some in each required form field under Wikipedia:Non-free content criteria. There should also be a option of some sort if a user proposes to use it in more than one article that would provide additional form fields for each user.

An additional option could be to prefill certain options such as Purpose or Replaceability, depending on the license selected and to make some options such as Low_resolution, a check box style, that must be checked yes to upload or that would trigger a review category added to the submission if no is selected.

Is possibly similar to Bug#:  4647