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Seven elementary and middle school teachers participated in this qualitative multiple case study (Stake, 2005) designed to explore how teachers design and modify formative assessment processes for their classrooms. Themes from the qualitative data (teacher and student interviews, participant-observation notes, classroom videos, and classroom artifacts) were identified using open-coding, axial coding, and cross case analysis. Four case studies document how teachers reflected on, discussed, and designed formative assessment processes, and then integrated them in unique ways into existing systems in their classroom. These teachers modified the formative assessment processes based on reflection, data, and student feedback. The themes that emerged through cross case analysis indicate conditions of classrooms that enable or impeded teacher ability to implement formative assessment processes.