Handwriting is an essential literacy and communication skill developed through a variety of instructional methods in elementary school. This study explored the consistency in handwriting instruction across grade levels in a Midwest public school district 15 years after the school initially implemented a uniform handwriting program. Additionally, the influence of the Common Core State Standards and Response to Intervention initiatives on handwriting instruction was reviewed. Participants included classroom teachers and personnel impacting handwriting instruction at the elementary schools. Data were collected using an electronic survey (n = 40) and individual, semi-structured interviews (n = 12). Survey results indicated that while most teachers followed the established guidelines, 24% still used other methods to teach handwriting. Interview themes described complexities of handwriting instruction, plenty of resources, and keeping up with changes. Advocacy for structured handwriting instruction, adequate practice, and application of handwriting during literacy activities continues to be a critical task for school-based occupational therapists.