Application to Extend/Change Nonimmigrant Status

USCIS Form I-539

Department of Homeland Security
U.S. Citizenship and Immigration Services
OMB No. 1615-0003
Applicant: Amanda Cintra de Andrade Expires: 09/30/2021
Receipt Number: MCT2179965623
Submission Date: 06-30-2021

Part 1. Information About You

Your Full Name
1.a. Family Name (Last Name): Andrade
1.b. Given Name (First Name): Amanda
1.c. Middle Name: Cintra de
2. Alien Registration Number (A-Number)(if any):
3. USCIS Online Account Number (if any):

U.S. Mailing Address

4.a. In Care Of Name (if any): Amanda Andrade
4.b. Street Number and Name: 1711 WINTERS PARK DR
4.c. Apt/Ste/Flr: APARTMENT
4.d. City or Town: DORAVILLE
4.e. State: GA
4.f. Zip Code: 30360-3216

U.S. Physical Address

5.a. Street Number and Name: 470 Cambridge Way Northeast
5.b. Apt/Ste/Flr:
5.c. City or Town: Sandy Spring
5.d. State: GA
5.e. Zip Code: 30328

Other Information About You

6. Country of Birth: BRA
7. Country Of Citizenship Or Nationality: BRA
8. Date of Birth (mm/dd/yyyy): 11-27-1992
9. US Social Security Number (if any): 085-57-8044
10. Date of Last Arrival Into the United States Address (mm/dd/yyyy): 08-12-2019
Provide Information About Your Most Recent Entry Into the United States
11. Form I-94 Arrival-Departure Record Number: 170836189A2
12. Passport Number: FY013634
13. Travel Document Number:
14.a. Country of Passport or Travel Document Issuance: BRA
14.b. Passport or Travel Document Expiration Date (mm/dd/yyyy): 01-23-2029
15.a. Current Nonimmigration Status (e.g., F-1 student, H-4 Dependent, etc.): J1
15.b. Expiration Date (mm/dd/yyyy): 08-11-2021
16. Select this box if you were granted Duration of Status (D/S): Yes

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 Part 2. Application Type
1./2./3.a. I am applying for: Change of Status
3.b. New Status and effective date of change (mm/dd/yyyy): 08-12-2021
3.c. The change of status I am requesting is: B2
Number of people included in this application:
4. I am the only applicant: Yes
5. The total number of people (including me) in the application is:

Part 3. Processing Information

1. I/We request that my/our current or requested status be extended until (mm/dd/yyyy): : 02-07-2021
2.a. Is this application based on an extension or change of status already granted to your spouse, child, or parent?: No
2.b. If you answered "Yes" to Item Number 2.a., provide USCIS Receipt Number.:
3.a. Is this application based on a separate petition or application to provide your spouse, child or parent an extension or a change
of status?: No
3.b. If pending with USCIS, provide USCIS Receipt Number:
If the petition or application is pending with USCIS, also provide the following information:
4.a. Last Name of Petitioner or applicant:
4.b. First Name of Petitioner or applicante:
5. Date Filed (mm/dd/yyyy:

Part 4. Additional Information About the Applicant

Provide Your Current Passport Information (if different from Part 1.):
1.a. Passport Number: FY013634
1.b. Country of Passport Issuance: BRA
1.c. Passport Expiration Date(mm/dd/yyyy): 01-23-2029

Physical Address Abroad

2.a. Street Number and Name: 2230 Major Elias Motta Avenue
2.b. Apt/Ste/Flr:
2.c. City or Town: Franca
2.d. Province: Sao Paulo
2.e. Postal Code: 14402-310
2.f Country: BRA

Answer the following questions. If you answer “Yes” to any of the questions in Item Numbers 3. - 15., use Additional
Information to provide an explanation.
3. Are you, or any other person included on the application, an applicant for an immigrant visa?: No
Additional Explanation:

4. Has an immigrant petition EVER been filed for you or for anyone included in this application?: No
Additional Explanation:

5. Has a Form I-485, Application to Register Permanent Residence or Adjust Status, EVER been filed by you or by anyone included in
this application?: No
Additional Explanation:

6. Have you, or any other person included in this application, EVER been arrested or convicted of any criminal offense since last
entering the United States?: No
Additional Explanation:

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 Have you, or any other person included on this application, EVER ordered, incited, called for, committed, assisted, helped with, or
otherwise participated in any of the following:
7.a. Acts involving torture or genocide: No
Additional Explanation:

7.b. Killing Any Person: No

Additional Explanation:

7.c. Intentionally and severely injuring any person: No

Additional Explanation:

7.d Engaging in any kind of sexual contact or relations with any person who did not consent or was unable to consent, or was being
forced or threatened: No
Additional Explanation:

7.e. Limiting or denying any person’s ability to exercise religious beliefs: No

Additional Explanation:

Have you, or any other person included on the application, EVER:

8.a. Served in, been a member of, assisted, or participated in any military unit, paramilitary unit, police unit, self-defense unit,
vigilante unit, rebel group, guerrilla group, militia, insurgent organization, or any other armed group? : No
Additional Explanation:

8.b. Worked, volunteered, or otherwise served in any prison, jail, prison camp, detention facility, labor camp, or any other situation
that involved detaining persons?: No
Additional Explanation:

9. Have you, or any other person included in this application, EVER been a member of, assisted, or participated in any group, unit,
or organization of any kind in which you or other persons used any type of weapon against any person or threatened to do so?: No
Additional Explanation:

10. Have you, or any other person included in this application, EVER assisted or participated in selling, providing, or transporting
weapons to any other person who, to your knowledge, used them against another person?: No
Additional Explanation:

11. Have you, or any other person included in this application, EVER received any type of military, paramilitary, or weapons
training?: No
Additional Explanation:

12. Have you, or any other person included in this application, done anything that violated the terms of the nonimmigrant status
you know hold?: No
Additional Explanation:

13. Are you, or any other person included in this application, now in removal proceedings?: No
If you answered “Yes” to Item Number 13., provide the following information concerning the removal proceedings in Additional
Information. Include the name of the individual in removal proceedings and information on jurisdiction, date proceedings began,
and status of proceedings.:
Additional Explanation:

14. Have you, or any other person included in this application, been employed in the United States since last admitted or granted
an extension or change of status?: No
If you answered “No” to Item Number 14., fully describe how you are supporting yourself in Additional Information. Include
documentary evidence of the source, amount, and basis for any income.:

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 Supporting Self Additional Explanation: I'm my self sponsor, actually I'm au pair and during my au pair year I save my money.
If you answered “Yes” to Item Number 14., fully describe the employment in Additional Information. Include the name of the
individual employed, name and address of the employer, weekly income, and whether the employment was specifically authorized
by USCIS.:
Employment Additional Explanation:

15. Are you, or any other person included in this application, currently or have you ever been a J-1 exchange visitor or J-2
dependent of a J-1 exchange visitor?: No
If you answered “Yes” to Item Number 15., you must provide the dates you maintained status as a J-1 exchange visitor or J-2
dependent in Additional Information.:
Additional Explanation:

Part 5. Applicant’s Statement, Contact Information, Declaration, Certification and Signature

Applicant’s Statement
1.a. I can read and understand English, and I have read and understand every question and instruction on this application and my
answer to every question: Yes
1.b. The interpreter named in Part 6. read to me every question and instruction on this application and my answer to every
question in , a language in which I am fluent, and I understood everything:
2. At my request, the preparer named in Part 7. , prepared this application for me based only upon information I provided or
authorized:

Applicant’s Contact Information

3. Applicant’s Daytime Telephone Number:
4. Applicant’s Mobile Telephone Number (if any): 404-660-7135
5. Applicant’s Email Address (if any): [email protected]

Applicant's Declaration and Certification

Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand
that USCIS may require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of
any information from any and all of my records that USCIS may need to determine my eligibility for the immigration
benefit that I seek.
I furthermore authorize release of information contained in this application, in supporting documents, and in my USCIS
records, to other entities and persons where necessary for the administration and enforcement of U.S. immigration law.
I understand that USCIS will require me to appear for an appointment to take my biometrics (fingerprints, photograph,
and/or signature) and, at that time, I will be required to sign an oath reaffirming that:
1) I reviewed and understood all of the information contained in, and submitted with, my application; and
2) All of this information was complete, true, and correct at the time of filing.
I certify, under penalty of perjury, that all of the information in my application and any document submitted with it
were provided or authorized by me, that I reviewed and understand all of the information contained in, and submitted
with, my application and that all of this information is complete, true, and correct.
Applicant’s Signature
6.a. Applicant's Signature: Amanda Cintra de Andrade
Signature Email Address: [email protected]
6.b. Date of Signature (mm/dd/yyyy): 06-30-2021
NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the
Instructions, USCIS may deny your application.

Part 6. Interpreter’s Contact Information, Statement, Certification, and Signature

Form I-539 Edition 03/10/21 Page 4 of 6

 Interpreter’s Full Name
1.a. Interpreter’s Family Name (Last Name):
1.b. Interpreter’s Given Name (First Name):
2. Interpreter’s Business or Organization Name (if any):

Interpreter’s Mailing Address

3.a. Street Number and Name:
3.a. Apt/Ste/Flr:
3.c. City or Town:
3.d. State:
3.e. Zip Code:
3.f. Province:
3.g. Postal Code:
3.h. Country:

Interpreter’s Contact Information

4. Interpreter’s Daytime Telephone Number:
5. Interpreter’s Mobile Telephone Number (if any):
6. Interpreter’s Email Address (if any):

Interpreter's Certification
I certify, under penalty of perjury, that:
I am fluent in English and , which is the same language specified in Part 5., Item Number 1.b., and I have read to this
applicant in the identified language every question and instruction on this application and his or her answer to every
question. The applicant informed me that he or she understands every instruction, question, and answer on the
application, including the Applicant's Declaration and Certification, and has verified the accuracy of every answer.
Interpreter’s Signature
7.a. Interpreter’s Signature:
7.b. Date of Signature (mm/dd/yyyy):

Part 7. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than
the Applicant
Preparer’s Full Name
1.a. Preparer’s Family Name (Last Name):
1.b. Preparer’s Given Name (First Name):
2. Preparer’s Business or Organization Name (if any):

Preparer’s Mailing Address

3.a. Street Number and Name:
3.b. Spt/Ste/Flr:
3.c. City or Town:
3.d. State:
3.e. Zip Code:
3.f. Province:
3.g. Postal Code:
3.h. Country:

Preparer’s Contact Information

4. Preparer’s Daytime Telephone Number:

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 5. Preparer’s Mobile Telephone Number (if any):
6. Preparer’s Email Address (if any):

Preparer’s Statement
7.a. I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and with the
applicant’s consent:
7.b. I am an attorney or accredited representative and by representation of the applicant in this case extends beyond the
preparation of this application:
NOTE: If you are an attorney or accredited representative, you may need to submit a completed Form G-28, Notice of
Entry of Appearance as Attorney or Accredited Representative, with this application.
Preparer's' Certification
By my signature, I certify, under penalty of perjury, that I prepared this application at the request of the applicant. The
applicant then reviewed this completed application and informed me that he or she understands all of the information
contained in, and submitted with, his or her application, including the Applicant's Declaration and Certification, and that
all of this information is complete, true, and correct. I completed this application based only on information that the
applicant provided to me or authorized me to obtain or use.
Preparer’s Signature
8.a. Preparer’s Signature:
8.b. Date of Signature (mm/dd/yyyy):

Part 8. Additional Information

Evidence Items
Original File Name: I-94.pdf
Category: I-94
Original File Name: Amanda Cintra de Andrade - Documentos Google.pdf
Category: Written Statements
Original File Name: Jun 30, Doc 1.pdf
Category: Other Supporting Documents

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