A pre-test post-test design was used to deliver the Size Matters Handwriting Program to 19 second-grade students using an occupational therapist-teacher collaborative teaching model. Outcomes from the Minnesota Handwriting Assessment indicate statistically and clinically significant gains for students in legibility, form, alignment, size, and spacing. Students' perceptions of self-monitoring, collected via a brief self-report measure, reveal that most students agreed that self-monitoring played an important role in their learning by understanding the rules of handwriting and learning proper spacing strategies when writing. These results support the effectiveness of employing the Size Matters Handwriting Program and teaching self-monitoring strategies.