Yes, UL can do this very easily.

At this time, to get to the form, the user will have to click a link first (as opposed to see the form immediately when they load the page). The link can be any text or image.

To prevent the user from seeing other names on the list, you will want to create a filter to not display the data.

You will also want to add a second UL module on another page which allows admins to see, sort, export, etc the email list.

Please let us know if you have any questions.