Do you need to have completed prereqs by application or matriculation?

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I believe so as long as you denote those courses as "In Progress" while doing the transcript part on the OptomCAS. Some schools may hold off until you finish those to see grades for all their pre-reqs just in case you don't pass I'm assuming.
 
I will be attending UAB in 2020, and I applied with one incomplete prerequisite course. I was given a conditional acceptance so long as I passed the course with a C or better by the time I matriculated.
However, I would check with your prospective programs to find out for certain what their procedure is. Most schools have information such as that on their websites I believe listed with their prerequisites.
 
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