Adding user input for the quick create folder is not possible.
But in the normal Create Folder dialog you can press F9 to current date and the you can insert your text
Or you can script it using MultiScript..
@var $targetFolder = GetSourcePath();
@var $now = GetTime();
@var $date = FormatDate( "yyyy-MM-dd" , $now );
@var $text = AskText("Enter text to add after date", "", 0);
@var $newFolder = $targetFolder ^ $date + "_" + $text;
MakeDir( $newFolder );
Then assign that script to a shotcut key or menu option.